Exacerbations in chronic obstructive pulmonary disease (COPD) in Ontario, Canada

<b>Background:</b> COPD is characterized by shortness of breath, sputum production, and cough. Exacerbations are associated with poor quality of life, healthcare resource use, and significant mortality. <b>Objective:</b> To estimate the frequency of exacerbations among the patients with COPD in Ontario. <b>Methods:</b> Patients ≥65 years with a new diagnosis of COPD were identified using health administrative data from 2004-20. All patients had a minimum follow-up of two years with the first year used to establish baseline severity. Moderate exacerbations were defined as a prescription for oral corticosteroids, respiratory antibiotics, or a COPD outpatient visit. Severe exacerbations included hospitalization or emergency department visit for COPD. Annual exacerbation rates were compared by baseline severity. <b>Results:</b> A total of 281,844 patients (mean[SD] age 75[7.2]) were identified with a median follow-up of 6 years. Compared to patients without exacerbations at baseline, those with any exacerbation had higher risk of repeat exacerbations during their follow-up, scaling by number of baseline exacerbations (Figure 1). <b>Conclusions:</b> Nearly half of the cohort experienced a moderate or worse exacerbation within the first year of diagnosis and these patients accounted for the majority of exacerbations in the follow-up years. These data indicate that physicians should make all efforts to diagnose patients early and treat to prevent further exacerbations.