Abstract Introduction Chronic obstructive pulmonary disease (COPD) patients with frequent exacerbations have a poor prognosis, characterized by worsening of health-related quality of life, a rapid decline in lung function, and a high risk of further exacerbation. We aimed to investigate the clinical factors associated with disease progression of this population. Methods Data from the Quality Improvement Program (QIP, NCT05638646), conducted between April 2023 and June 2025, were analyzed, including 989 COPD patients with frequent exacerbations from 40 hospitals in 5 areas (the east, north, west, south, and central) in China. Disease progression was defined as meeting any of the following criteria within 48 weeks: a moderate or severe exacerbation, a decline in trough FEV1 of 100 mL, or an increase in the CAT score of 2 units. A total of 26 clinical factors were analyzed, categorized into basic characteristics, environmental risk factors, disease burden indicators, treatment, and inhaled therapy management. Multivariate logistic regression was performed to determine the significant factors associated with disease progression. Results The incidences of moderate or severe exacerbation, a decline in trough FEV1 of 100 mL, and an increase in the CAT score of 2 units were 35.9% (355/989), 31.3% (265/846) and 14.6% (130/892), respectively. Factors associated with exacerbations during the follow-up included use of antitussive/mucolytics/cough-mucolytics at visit 1, use of LAMA at baseline, use of ICS+LABA at baseline, use of LABA+LAMA at baseline, use of methylxanthines at visit 1, severe exacerbation in the past 12 month, and baseline trough FEV1. Baseline trough FEV1, severe exacerbation in the past 12 months, and age were associated with the decline in trough FEV1. Use of antitussive/mucolytics/cough-mucolytics at visit 1, severe exacerbation in the past 12 month, baseline CAT score, baseline trough FEV1, use of ICS+LABA+LAMA at visit 1, and use of LABA+LAMA at visit 1 were associated with the increase in CAT scores. Conclusions This study identified distinct sets of clinical factors associated with different manifestations of disease progression in COPD patients with frequent exacerbations. Notably, regular use of either LABA+LAMA or ICS+LABA+LAMA was associated with less CAT increase. Future studies are needed to determine whether targeting these factors can effectively slow disease progression in this high-risk population. This abstract is funded by: AstraZeneca China
Yang et al. (Fri,) studied this question.