Determinants of exacerbation risk in patients with COPD in the TIOSPIR study

Peter M.A. Calverley, Kay Tetzlaff, Daniel Dusser, Robert A. Wise, Achim Mueller, Norber Metzdorf, Antonio Anzueto

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: Exacerbation history is used to grade the risk of COPD exacerbation, but its reliability and relationship to other risk factors and prior therapy is unclear. To examine these interrelationships, we conducted a post hoc analysis of patients in the TIOSPIR trial with ≥2 years’ follow-up or who died on treatment. Patients and methods: Patients were grouped by their annual exacerbation rate on treatment into nonexacerbators, infrequent, and frequent exacerbators (annual exacerbation rates 0, ≤1, and <1, respectively), and baseline characteristics discriminating among the groups were determined. We used univariate and multivariate analyses to explore the effect of baseline characteristics on risk of exacerbation, hospitalization (severe exacerbation), and death (all causes). Results: Of 13,591 patients, 6,559 (48.3%) were nonexacerbators, 4,568 (33.6%) were infrequent exacerbators, and 2,464 (18.1%) were frequent exacerbators; 45% of patients without exacerbations in the previous year exacerbated on treatment. Multivariate analysis identified baseline pulmonary maintenance medication as a predictive factor of increased exacerbation risk, with inhaled corticosteroid treatment associated with increased exacerbation risk irrespective of exacerbation history. Conclusion: Our data confirm established risk factors for exacerbation, but highlight the limitations of exacerbation history when categorizing patients and the importance of prior treatment when identifying exacerbation risk.

Original languageEnglish (US)
Pages (from-to)3391-3405
Number of pages15
JournalInternational Journal of COPD
StatePublished - Nov 29 2017


  • COPD
  • Exacerbation
  • Frequent exacerbators

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Health Policy
  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Determinants of exacerbation risk in patients with COPD in the TIOSPIR study'. Together they form a unique fingerprint.

Cite this