Risk Factors for Progression to Frequent Exacerbators in Stable Patients with Chronic Obstructive Pulmonary Disease

Q: What outcome defines progression in this study of COPD patients?

Progression is defined as moving from an infrequent exacerbator state to frequent exacerbators within 1 year.

Q: Which patient factors were associated with progression to frequent exacerbators?

Older age, decreased post-bronchodilator FEV1 % predicted, increased blood eosinophil count, and use of ICS-containing inhalers were associated with progression.

Q: How did eosinophil levels affect the prediction of progression?

In stratified analysis, decreased post-bronchodilator FEV1 and ICS-containing inhalers predicted progression among patients with eosinophils <300/μL, while eosinophils ≥300/μL showed a nonsignificant trend.

Sep 30, 2026

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Study evaluates the transition from infrequent to frequent exacerbators in stabilized chronic obstructive pulmonary disease (COPD). Using Korean COPD Subgroup Study cohort (KOCOSS) data, outcomes assessed progression over 1 year among 511 infrequent exacerbators. Multivariable logistic regression identified risk factors for progression, including older age, worse lung function by decreased percent-predicted post-bronchodilator FEV1, higher blood eosinophil counts, and use of inhaled corticosteroid (ICS)-containing inhalers. Stratified results showed stronger prediction in patients with eosinophils <300/μL.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

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Abstract

Background

Methods

Results

Conclusion

Introduction

Original Article Risk Factors for Progression to Frequent Exacerbators in Stable Patients with Chronic Obstructive Pulmonary Disease Sang Hyuk Kim1,2, Hye Yun Park3, Hyun Lee4, Hyewon Seo5, Ji-Hyun Lee6, Hyeon-Kyoung Koo7, Na Young Kim8, Kwang Ha Yoo9, Ju Ock Na10 and Youlim Kim9 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, 2Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, 3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 4Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, 6Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, 8Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, 9Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, 10Division of Pulmonology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea Abstract Background: Little is known about the transition to frequent exacerbators in stabilized patients with chronic obstructive pulmonary disease (COPD) . Methods: This study utilized data obtained from the Korean COPD Subgroup Study cohort (KOCOSS), including 511 infrequent exacerbators. The outcome for these groups was progression to frequent exacerbators. Multivariable logistic regression analysis was used to investigate the risk factors for progression. Results: Within 1 year, 40 patients (7 .8%) progressed to frequent exacerbators. Among patients with severe airflow limitation and those who used inhaled corticosteroids (ICS), the incidence of progression was significantly higher. The risk factors for this progression were older age (adjusted odds ratio [aOR], 2.01; 95% confidence interval [CI], 1.19 to 3.39 per 10-year increase), decreased percent-predicted post-bronchodilator forced expiratory volume in 1 second (FEV1 %predicted, aOR, 1. 32; 95% CI, 1.05 to 1.66 per 10% predicted decrease), increased blood eosinophil count (aOR, 1.20; 95% CI, 1.07 to 1.35 per 100 cells/μL increase), and use of ICS-containing inhalers (aOR, 3.30; 95% CI, 1.59 to 6. 85) . In stratified analysis, decreased percent-predicted post-bronchodilator FEV₁ (aOR, 1.39; 95% CI, 1.05 to 1.85 per 10%pred decrease) and ICS-containg inhalers (aOR, 4 .01; 95% CI, 1.61 to 9 .95) predicted progression among patients with eosinophils <300/μL, while higher eosinophils ≥300/μL showed a nonsignificant trend (aOR, 1.16; 95% CI, 1.00 to 1.36; p=0 .058) . Conclusion: Among stable COPD patients, older age, decreased lung function, an increased eosinophil count, and use of ICS-containing inhalers were associated with progression to frequent exacerbators. Keywords: Chronic Obstructive Pulmonary Disease; Disease Progression; Prediction; Exacerbation; Eosinophil [https://doi.org/10.4046/trd.2025.0058](https://doi.org/10.4046/trd.2025.0058) ISSN: 1738-3536(Print)/ 2005-6184(Online) Tuberc Respir Dis 2026;89:65-74 Copyright © 2026 The Korean Academy of Tuberculosis and Respiratory Diseases Address for correspondence Youlim Kim Division of Pulmonary and Allergy, Department

FAQs

What outcome defines progression in this study of COPD patients?

Progression is defined as moving from an infrequent exacerbator state to frequent exacerbators within 1 year.

Which patient factors were associated with progression to frequent exacerbators?

Older age, decreased post-bronchodilator FEV1 % predicted, increased blood eosinophil count, and use of ICS-containing inhalers were associated with progression.

How did eosinophil levels affect the prediction of progression?

In stratified analysis, decreased post-bronchodilator FEV1 and ICS-containing inhalers predicted progression among patients with eosinophils <300/μL, while eosinophils ≥300/μL showed a nonsignificant trend.

Sep 30, 2026

Uploaded by Mabel