Exploring Patterns of COPD Exacerbations and Comorbid Flare-Ups

Sanne H B van Dijk; Marjolein G J Brusse-Keizer; Tanja Effing; Paul D L P M van der Valk; Eline H Ploumen; Job van der Palen; Carine J M Doggen; Anke Lenferink

doi:10.2147/COPD.S428960

Exploring Patterns of COPD Exacerbations and Comorbid Flare-Ups

Int J Chron Obstruct Pulmon Dis. 2023 Nov 16:18:2633-2644. doi: 10.2147/COPD.S428960. eCollection 2023.

Authors

Sanne H B van Dijk^{1

2}, Marjolein G J Brusse-Keizer^{1

3}, Tanja Effing^{4

5}, Paul D L P M van der Valk², Eline H Ploumen^{1

6}, Job van der Palen^{3

7}, Carine J M Doggen^{1

8}, Anke Lenferink^{1

2

8}

Affiliations

¹ Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands.
² Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.
³ Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands.
⁴ College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia.
⁵ School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
⁶ Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands.
⁷ Cognition, Data & Education, BMS Faculty, University of Twente, Enschede, the Netherlands.
⁸ Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands.

Abstract

Background: Comorbidities are known to complicate disease management in patients with Chronic Obstructive Pulmonary Disease (COPD). This is partly due to lack of insight into the interplay of acute exacerbations of COPD (AECOPD) and comorbid flare-ups. This study aimed to explore patterns of AECOPDs and comorbid flare-ups.

Methods: Data of increased symptoms were extracted from a 12-month daily symptom follow-up database including patients with COPD and comorbidities (chronic heart failure (CHF), anxiety, depression) and transformed to visualizations of AECOPDs and comorbid flare-up patterns over time. Patterns were subsequently categorized using an inductive approach, based on both predominance (ie, which occurs most often) of AECOPDs or comorbid flare-ups, and their simultaneous (ie, simultaneous start in ≥ 50%) occurrence.

Results: We included 48 COPD patients (68 ± 9 years; comorbid CHF: 52%, anxiety: 40%, depression: 38%). In 25 patients with AECOPDs and CHF flare-ups, the following patterns were identified: AECOPDs predominant (n = 14), CHF flare-ups predominant (n = 5), AECOPDs nor CHF flare-ups predominant (n = 6). Of the 24 patients with AECOPDs and anxiety and/or depression flare-ups, anxiety and depression flare-ups occurred simultaneously in 15 patients. In 9 of these 24 patients, anxiety or depression flare-ups were observed independently from each other. In 31 of the included 48 patients, AECOPDs and comorbid flare-ups occurred mostly simultaneously.

Conclusion: Patients with COPD and common comorbidities show a variety of patterns of AECOPDs and comorbid flare-ups. Some patients, however, show repetitive patterns that could potentially be used to improve personalized disease management, if recognized.

Keywords: anxiety; chronic obstructive pulmonary disease; depression; disease monitoring; heart failure; personalized medicine.

MeSH terms

Anxiety Disorders / epidemiology
Chronic Disease
Comorbidity
Disease Progression
Heart Failure* / diagnosis
Heart Failure* / epidemiology
Humans
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / epidemiology

Grants and funding

The COPE-III study was supported by Stichting Astma Bestrijding, the Lung Foundation Netherlands (grant number 3.4.11.061), Lung Foundation Australia (Australian Lung Foundation Boehringer Ingelheim COPD Research Fellowship 2010), Repat Foundation, and GlaxoSmithKline (unrestricted grant). This work was supported by the European Union’s Horizon 2020 research and innovation program (grant number 965315).