Critical inhaler handling error is an independent risk factor of frequent exacerbation of chronic obstructive pulmonary disease = Critical inhaler handling error is an independent risk factor of frequent exacerbation of chronic obstructive pulmonary disease

다국어 초록 (Multilingual Abstract)

Background: Acute exacerbations are significant event of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients. “Frequent exacerbator” phenotypes are considered as a distinct subgroup. The objective of this study was to evaluate risk factors associated with frequent exacerbations of COPD in Korean tertiary university hospital patients. Methods: The study was designed as a cross sectional, case-control study. We prospectively enrolled 261 COPD patients at Yeungnam University Hospital from January 2018 to November 2018. Subjects were tested their inhaler technique at study entry. Frequency of moderate to severe COPD exacerbations were reviewed retrospectively via electronic medical records during 12 months prior to study entry. “Frequent exacerbations” were defined as ≥2 moderate to severe exacerbations in the last 12 months. Multivariate logistic regression was performed to identify the risk factors of frequent exacerbations. Results: Among 261 COPD patients enrolled, 65 (24.9%) patients were “frequent exacerbator”. Frequent exacerbators had lower forced expiratory volume in 1 s (FEV1), lower forced vital capacity (FVC), higher mMRC, longer duration of inhaler usage, lower body mass index (BMI), higher critical inhaler handling error (<0.05). In multivariate analysis, longer duration of inhaler usage (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.00-1.19; p=0.041), lower BMI (OR, 0.91, 95% CI, 0.83-0.99; p=0.032), critical inhaler handling error (OR, 1.92, 95% CI, 1.06-3.48; p=0.032), low FVC (OR, 0.97, 95% CI, 0.95-0.99; p=0.005) were associated with frequent exacerbations. Conclusions: Our data revealed that longer duration of inhaler usage, lower BMI, critical inhaler handling error and low FVC are independent risk factors of frequent exacerbations in COPD patients. Careful monitoring and education in inhaler use devices, especially in “frequent exacerbators” are important part of COPD treatment.