Acute Exacerbations of Chronic Obstructive Pulmonary Disease and Associated Risk Factors: A Hospital-Based Observational Study

Abstract

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) accelerate lung-function decline, impair quality of life and increase hospitalisation and mortality. Identifying the factors that drive them is central to prevention. This study determined the frequency of AECOPD over one year and the factors independently associated with frequent exacerbations.

Methods: A hospital-based prospective observational study enrolled 320 patients with spirometry-confirmed COPD (post-bronchodilator FEV₁/FVC < 0.70) who were followed for 12 months. Exacerbations were defined per GOLD criteria; patients with ≥2 moderate-to-severe events were classed as frequent exacerbators. Demographic, clinical, spirometric, environmental and laboratory variables were analysed by univariable and multivariable logistic regression, reporting adjusted odds ratios (aOR) with 95% confidence intervals (CIs).

Results: Ninety-seven patients (30.3%) were frequent exacerbators. On multivariable analysis, prior-year exacerbation history was the strongest independent predictor (aOR 4.62, 95% CI 2.71–7.88), followed by severe airflow limitation (FEV₁ < 50% predicted; aOR 2.84), high symptom burden (mMRC ≥2; aOR 2.11), gastro-oesophageal reflux disease (aOR 1.98), cardiovascular comorbidity (aOR 1.83), elevated blood eosinophils ≥300 cells/µL (aOR 1.76) and current smoking (aOR 1.69).

Conclusion: Prior exacerbation history was the dominant predictor of frequent exacerbations. Because several identified factors are modifiable, risk stratification anchored on exacerbation history—combined with optimised therapy, comorbidity management and reduction of harmful exposures—offers a practical route to prevention.