Previous exacerbations in newly diagnosed COPD patients: do they matter?

Extract

The current Global Initiative for Chronic Obstructive Lung Disease (GOLD) document defines a COPD patient at risk of an exacerbation as one who has had two or more moderate exacerbations (requiring systemic steroids or antibiotics) or at least one severe exacerbation (requiring hospitalisation) in the previous year [1]. This definition is based on the predictive risk of previous exacerbations in COPD patients with a long-established disease currently receiving medication (long-acting bronchodilators and inhaled corticosteroids (ICS)) [2]. In the 2024 document, the GOLD committee has, for the first time, proposed that newly diagnosed COPD patients with exacerbations could be eligible for triple inhaled therapy (long-acting β₂-agonist (LABA) with long-acting muscarinic antagonist and ICS) as their initial medication if they have more than 300 eosinophils per μL of blood. However, there is little to no evidence on how newly diagnosed COPD patients progress in the year following their diagnosis, particularly concerning previous exacerbations. A knowledge gap exists regarding whether exacerbations in the previous year could predict future exacerbations in newly diagnosed COPD patients, as opposed to only those with established disease under chronic treatment. This could have therapeutic implications, as it would encourage more aggressive treatment for exacerbators from the time of diagnosis and might suggest reconsidering the necessity of waiting for a second exacerbation before initiating triple inhaled therapy, especially in patients who have a blood eosinophil count >300 μL^–1.