Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study

We investigated the impact of season relative to other determinants of chronic obstructive pulmonary disease (COPD) exacerbation frequency in a long-term international study of patients with forced expiratory volume in 1 s (FEV(1)) <60% predicted. COPD exacerbations were defined by worsening symp...

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Bibliographic Details
Published in:	The European respiratory journal Vol. 39; no. 1; pp. 38 - 45
Main Authors:	JENKINS, C. R, CELL, B, ANDERSON, J. A, FERGUSON, G. T, JONES, P. W, VESTBO, J, YATES, J. C, CALVERLE, P. M. A
Format:	Journal Article
Language:	English
Published:	Leeds Maney 01-01-2012
Subjects:	Adrenal Cortex Hormones - therapeutic use Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Biological and medical sciences Chronic obstructive pulmonary disease, asthma Double-Blind Method Female Forced Expiratory Volume Hospitalization Humans Male Medical sciences Middle Aged Models, Statistical Pneumology Pulmonary Disease, Chronic Obstructive - physiopathology Pulmonary Disease, Chronic Obstructive - therapy Pulmonary Medicine - methods Risk Seasons Treatment Outcome Lung disease Prognosis Respiratory disease Mortality Survival seasonal patterns Chronic TORCH survival study exacerbations Bronchus disease Chronic obstructive pulmonary disease Obstructive pulmonary disease Severe Pneumology
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Summary:	We investigated the impact of season relative to other determinants of chronic obstructive pulmonary disease (COPD) exacerbation frequency in a long-term international study of patients with forced expiratory volume in 1 s (FEV(1)) <60% predicted. COPD exacerbations were defined by worsening symptoms requiring systemic corticosteroids and/or antibiotics (moderate) or hospital admission (severe). Seasonality effect was calculated as the proportion of patients experiencing an exacerbation each month. Exacerbations in the northern and southern regions showed an almost two-fold increase in the winter months. No seasonal pattern occurred in the tropics. Overall, 38% of exacerbations were treated with antibiotics only, 19% with systemic corticosteroids only and 43% with both, while 20% required hospital admission irrespective of the season. Exacerbation frequency was associated with older age, lower body mass index, lower FEV(1) % pred and history of prior exacerbations. Females and patients with worse baseline breathlessness, assessed using the Medical Research Council (MRC) dyspnoea scale, exacerbated more often (rate ratio (RR) for male versus female 0.7, 95% CI 0.7-0.8 (p<0.001); RR for MRC dyspnoea score 3 versus 1 and 2 combined 1.1, 95% CI 1.1-1.2 (p<0.001)). The effect of season was independent of these risk factors. COPD exacerbations and hospitalisations were more frequent in winter.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23
ISSN:	0903-1936 1399-3003
DOI:	10.1183/09031936.00194610