Background: Patients with chronic obstructive pulmonary disease (COPD) can be categorized as having frequent\r\n(FE) or infrequent (IE) exacerbations depending on whether they respectively experience two or more, or one or\r\nzero exacerbations per year. Although most patients do not change category from year to year, some will, and the\r\nfactors associated with this behaviour have not been examined.\r\nMethods: 1832 patients completing two year follow-up in the Evaluation of COPD Longitudinally to Identify\r\nPredictive Surrogate End-points (ECLIPSE) study were examined at baseline and then yearly. Exacerbations were\r\ndefined by health care utilisation. Patient characteristics compared between those patients who did or did not\r\nchange exacerbation category from year 1 to year 2.\r\nFindings: Between years 1 and 2, 221 patients (17%) changed from IE to FE and 210 patients (39%) from FE to IE.\r\nMore severe disease was associated with changing from IE to FE and less severe disease from FE to IE. Over the\r\npreceding year, small falls in FEV1 and 6-minute walking distance were associated with changing from IE to FE, and\r\nsmall falls in platelet count associated with changing from FE to IE.\r\nConclusion: No parameter clearly predicts an imminent change in exacerbation frequency category.
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