Transitions to and reversion from a persistent frequent-exacerbator state in COPD.

Authors

Delphine Vauterin, Frauke Van Vaerenbergh, Lowie E G W Vanfleteren, Lies Lahousse

Published in

ERJ open research. Volume 12. Issue 3. Epub Jun 22, 2026.

Abstract

Preventing acute exacerbations in COPD (AECOPDs) is key in striving for disease stability. To investigate the differential impact of risk factors across AECOPD phenotypes, we identified baseline health determinants and comorbidities associated with transitions from non-exacerbator (NE) to persistent frequent-exacerbator (FE) and reversion.
Patients ≥45 years with ≥3 months treatment for obstructive airway diseases or hospital-labelled COPD without (concomitant) asthma were identified in Belgian nationwide data between January 2017-February 2018. Factors associated with disease worsening (transitioning from NE to persistent FE), reversion (from FE to stable NE) or transition to death were investigated using multinomial logistic regression.
Among 183 762 patients (mean age 68.6 years, 48.0% female), 11.5% (21 072) never experienced AECOPDs and 11.6% (21 375) exacerbated frequently in each of three consecutive years. Among 56 933 NE at baseline (31.0%), 4.1% transitioned to persistent FE, whereas among 80 502 FE (43.8%), 7.3% reversed to stable NE. Transitions from NE towards persistent FE were associated with having lung cancer (adjusted odds ratio (aOR) 3.67, 95% CI 2.33-5.78), being an ever-smoker (aOR 2.09, 95% CI 1.94-2.43) or having neuropsychiatric or musculoskeletal comorbidity. Overuse of short-acting bronchodilators (aOR 0.57, 95% CI 0.46-0.49), ever-smoking or having overuse of maintenance therapy were factors most strongly associated with lower odds of reversion. Cardiovascular comorbidities were significantly associated with increased mortality odds, but not with disease worsening.
The results of this cohort study support addressing smoking and inhaler overuse to promote reversion to stable NE, while managing lung cancer and neuropsychiatric or musculoskeletal comorbidities to reduce worsening.

PMID:
42338677
Bibliographic data and abstract were imported from PubMed on 24 Jun 2026.

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