RATIONALE: COPD patients(pts) may suffer from recurrent exacerbations(ex) and experience a rapid deterioration of health status and lung function and may die early in the course of the disease.Substantial social burden and costs do rise. So studies over the years tried to reduce ex rate by various interventions , mostly pharmacologic assays. These studies generally demonstrated a selection bias in favour of a frequently exacerbating phenotype("Chasing exacerbations"]). But living COPD for pts and physicians is more than suffering from or the prevention of ex. METHODS:2011 - 2013, as described earlier, more than 1700 pts in a multicenter outpatient setting were asked via questionnaire for number and severity of ex in the past three years. More data were collected concerning smoking habit, medication and comorbidities.(COPD spirometric severity I - IV) RESULTS: The study group found three essential subgroups/phenotypes; a minority of 85 pts (5%) had 2 or more ex/year as defined as frequent exacerbator in recent literature. Only 2 % of ex treated were so in a hospital setting. The majority of 1055 pts(60%) did not experience an ex in all categories of severity. 86% of all pts were treated with longacting agents LABA or LAMA or ICS or Roflumilast or combinations of these. There were differences in age, smoking habit, number and severity of comorbidities, medication. 190 pts. had no longacting medication at all. Discussion: The data in this population fail to show exacerbations as one of the major problems in treating COPD.We must learn to differentiate what to treat . Improving dyspnea, cough and lung function are major goals but less discussed.
Klopf et al. (Mon,) studied this question.