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Drivers of year-to-year variation in exacerbation frequency of COPD: analysis of the AERIS cohort

Drivers of year-to-year variation in exacerbation frequency of COPD: analysis of the AERIS cohort
Drivers of year-to-year variation in exacerbation frequency of COPD: analysis of the AERIS cohort
The association between exacerbation aetiology and exacerbation frequency is poorly understood. We analysed 2-year follow-up data from a prospective observational study of patients with chronic obstructive pulmonary disease (COPD) (www.clinicaltrials.gov identifier number NCT01360398) to evaluate year-to-year variation in exacerbation frequency and related aetiology. A total of 127 patients underwent blood and sputum sampling monthly and at exacerbation to detect respiratory infections and eosinophilic inflammation; 103 continued into year 2 and 88 completed both years. The most common bacterial species at stable state and exacerbation was Haemophilus influenzae. Among infrequent exacerbators (one exacerbation per year), the incidence of viral infection at exacerbation was high (60.0% (95% CI 35.1–81.7%) in year 1 and 78.6% (53.4–94.2%) in year 2). Those with more frequent exacerbations tended to have higher relative incidence of bacterial than viral infection. Patients with at least two additional exacerbations in year 2 versus year 1 had a higher risk of H. influenzae colonisation at stable state than those with at least two fewer exacerbations, as detected by culture (OR 1.43 (95% CI 0.71–2.91) versus 0.63 (0.40–1.01), p=0.06) and PCR (1.76 (95% CI 0.88–3.51) versus 0.56 (0.37–0.86), p<0.01). This was not seen with other infection types or eosinophilic inflammation. Analysis of the same cohort over 2 years showed, for the first time, that changes in yearly COPD exacerbation rate may be associated with variations in H. influenzae colonisation.
2312-0541
Wilkinson, Tom M.A.
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Aris, Emmanuel
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Bourne, Simon C.
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Clarke, Stuart C.
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Peeters, M.
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Pascal, Thierry G.
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Taddei, Laura
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Tuck, Andrew C
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Kim, Viktoriya L.
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Ostridge, Kristoffer
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Staples, Karl J.
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Williams, Nicholas, Paul
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Williams, Anthony P.
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Wootton, Stephen A.
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Devaster, Jeanne-Marie
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Wilkinson, Tom M.A.
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Aris, Emmanuel
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Bourne, Simon C.
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Clarke, Stuart C.
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Peeters, M.
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Pascal, Thierry G.
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Taddei, Laura
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Tuck, Andrew C
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Kim, Viktoriya L.
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Ostridge, Kristoffer
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Staples, Karl J.
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Williams, Nicholas, Paul
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Williams, Anthony P.
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Wootton, Stephen A.
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Devaster, Jeanne-Marie
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Wilkinson, Tom M.A., Aris, Emmanuel, Bourne, Simon C., Clarke, Stuart C., Peeters, M., Pascal, Thierry G., Taddei, Laura, Tuck, Andrew C, Kim, Viktoriya L., Ostridge, Kristoffer, Staples, Karl J., Williams, Nicholas, Paul, Williams, Anthony P., Wootton, Stephen A. and Devaster, Jeanne-Marie (2019) Drivers of year-to-year variation in exacerbation frequency of COPD: analysis of the AERIS cohort. ERJ Open Research, 5. (doi:10.1183/23120541.00248-2018).

Record type: Article

Abstract

The association between exacerbation aetiology and exacerbation frequency is poorly understood. We analysed 2-year follow-up data from a prospective observational study of patients with chronic obstructive pulmonary disease (COPD) (www.clinicaltrials.gov identifier number NCT01360398) to evaluate year-to-year variation in exacerbation frequency and related aetiology. A total of 127 patients underwent blood and sputum sampling monthly and at exacerbation to detect respiratory infections and eosinophilic inflammation; 103 continued into year 2 and 88 completed both years. The most common bacterial species at stable state and exacerbation was Haemophilus influenzae. Among infrequent exacerbators (one exacerbation per year), the incidence of viral infection at exacerbation was high (60.0% (95% CI 35.1–81.7%) in year 1 and 78.6% (53.4–94.2%) in year 2). Those with more frequent exacerbations tended to have higher relative incidence of bacterial than viral infection. Patients with at least two additional exacerbations in year 2 versus year 1 had a higher risk of H. influenzae colonisation at stable state than those with at least two fewer exacerbations, as detected by culture (OR 1.43 (95% CI 0.71–2.91) versus 0.63 (0.40–1.01), p=0.06) and PCR (1.76 (95% CI 0.88–3.51) versus 0.56 (0.37–0.86), p<0.01). This was not seen with other infection types or eosinophilic inflammation. Analysis of the same cohort over 2 years showed, for the first time, that changes in yearly COPD exacerbation rate may be associated with variations in H. influenzae colonisation.

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Wilkinson et al 2019 ERJ Open Res - Version of Record
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e-pub ahead of print date: 25 February 2019

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Local EPrints ID: 428729
URI: https://eprints.soton.ac.uk/id/eprint/428729
ISSN: 2312-0541
PURE UUID: d806668b-9393-4c40-920e-83a701c61449
ORCID for Stuart C. Clarke: ORCID iD orcid.org/0000-0002-7009-1548
ORCID for Karl J. Staples: ORCID iD orcid.org/0000-0003-3844-6457

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Date deposited: 07 Mar 2019 17:30
Last modified: 14 Mar 2019 01:41

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Contributors

Author: Emmanuel Aris
Author: Simon C. Bourne
Author: M. Peeters
Author: Thierry G. Pascal
Author: Laura Taddei
Author: Andrew C Tuck
Author: Viktoriya L. Kim
Author: Kristoffer Ostridge
Author: Karl J. Staples ORCID iD
Author: Nicholas, Paul Williams
Author: Jeanne-Marie Devaster

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