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Susceptibility to frequent exacerbation in COPD patients: Impact of the exacerbations history, vaccinations and comorbidities?
Ouaalaya, El Hassane; Falque, Laurent; Dupis, Jean Michel; Sabatini, Marielle; Bernady, Alain; Nguyen, Laurent; Ozier, Annaig; Nocent-Ejnaini, Cécilia; Le Guillou, Frédéric; Molimard, Mathieu; Zysman, Maéva; Raherison-Semjen, Chantal.
Afiliación
  • Ouaalaya EH; Bordeaux University, INSERM, Bordeaux Population Health Research Center, team: EPICENE, UMR1219, Bordeaux, France. Electronic address: el-hassane.ouaalaya@u-bordeaux.fr.
  • Falque L; Polyclinique Bordeaux Rive Droite, Lormont, France.
  • Dupis JM; Cabinet Medical Pessac, Pessac, France.
  • Sabatini M; CHG Côte Basque, Bayonne, France.
  • Bernady A; Medical Center TOKI EDER, Cambo les bains, France.
  • Nguyen L; Polyclinique Saint-Augustin, Bordeaux, France.
  • Ozier A; Polyclinique Saint-Augustin, Bordeaux, France.
  • Nocent-Ejnaini C; CHG Côte Basque, Bayonne, France.
  • Le Guillou F; Cabinet Medical, la Rochelle, France.
  • Molimard M; Bordeaux University, INSERM, Bordeaux Population Health Research Center, team Pharmaco-epidemiology, UMR 1219, Bordeaux, France.
  • Zysman M; Bordeaux University, INSERM, Cardiothoracic Research Center of Bordeaux, team: 2, UMR1045, Bordeaux, France.
  • Raherison-Semjen C; Bordeaux University, INSERM, Bordeaux Population Health Research Center, team: EPICENE, UMR1219, Bordeaux, France; CHU de Bordeaux, Pole Cardiothoracique, Respiratory Diseases Department, Bordeaux, France.
Respir Med ; 169: 106018, 2020 08.
Article en En | MEDLINE | ID: mdl-32442114
INTRODUCTION: Exacerbations are key events in the natural history of COPD, but our understanding of their longitudinal determinants remains unclear. We used data from a large observational study to test the hypothesis that vaccination status and comorbidities could be associated with the occurrence of exacerbations profile. METHODS: Diagnosed COPD patients have been included by their pulmonologists, with up to 3 years of follow-up. Data were analyzed using the KmL method designed to cluster longitudinal data and receiver operating characteristic curve analysis to determine the best threshold to allocate patients to identified clusters. RESULTS: 932 COPD patients were included since January 2014, 446 patients (65.68% males, 35.59% current smokers) were followed over a period of 3 years with complete data. 239(28.15%) patients reported two or more exacerbations in the year before enrolment (frequent exacerbations). Among them 142(16.68%) also had frequent exacerbations in the first year of the study, and 69(8.10%) who remained frequent exacerbators in the second year. Based on our hypothesis, we were able to determine four phenotypes: A (infrequent), B (frequent in underweight patients), C (transient), and D (frequent in obese patients). Frequent exacerbators had more airflow limitation and symptoms. Irrespective of cut-offs set to define the optimal number of clusters, a history of exacerbations OR: 3.72[2.53-5.49], presence of anxiety OR: 2.03[1.24-3.31] and absence of the annual influenza vaccination OR: 1.97[1.20-3.24] remained associated with the frequent exacerbator phenotypes. CONCLUSIONS: The most important determinants of frequent exacerbations are a history of exacerbations, anxiety and unvaccinated against influenza.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vacunación / Enfermedad Pulmonar Obstructiva Crónica Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Respir Med Año: 2020 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vacunación / Enfermedad Pulmonar Obstructiva Crónica Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Respir Med Año: 2020 Tipo del documento: Article Pais de publicación: Reino Unido