Key Points
• Source: Therapeutic Advances in Respiratory Disease
• Relevance: “These models predicting rates of moderate/severe exacerbations can be applied to a broad range of patients with COPD in terms of airway obstruction, eosinophil counts, exacerbation history, symptoms, and treatment history. Understanding the relative and absolute risks related to these factors may be useful for clinicians in evaluating the benefit: risk ratio of various treatment decisions for individual patients.”
• UK researchers formulated models based on multinational clinical trial data (n=20,054). They used baseline risk factors to predict moderate/severe COPD exacerbations during the following year on various pharmacotherapies.
• The models demonstrated agreement between predicted and observed exacerbations rates, with a positive predictive value of 48% and a negative predictive value of 80%.
• “Even a single exacerbation can result in negative health outcomes for patients,” the authors wrote. “Therefore, proactively identifying patients predicted to have a high rate of exacerbations and optimizing treatment to prevent future exacerbations should be a key aim of COPD management. Notably, many of the risk factors shown to be important in our model can be modified or improved (e.g. FEV1% predicted, smoking status, and CAT score), suggesting that exacerbation risk can be modulated through treatment and lifestyle changes.”
• The current models demonstrated the largest treatment benefits with ICS-containing treatments compared with LAMA/LABA, which was expected of patients with previous ICS use, increased eosinophil count, and previous exacerbation history.
• Strengths of the current models include being based on diverse population data vs. data from a single or country region. These models are the first to predict absolute exacerbation rates in those patients taking various medications.
• Limitations of the current study include non-inclusion of patients with mild airflow obstruction, patients with asthma, or never-smokers, thus the model may not be dependable in these populations. Additionally, the patient population of the study included those at low- and high-risk for exacerbation, with the assumption that treatments functioned equally well.