Prior exacerbation history is used to guide initial maintenance therapy in COPD; however, the recommendations were derived from patients already diagnosed and treated.

We assessed the rates of moderate (i.e. treated with antibiotics and/or systemic corticosteroids) and severe (i.e. hospitalised) exacerbations in the year following diagnosis in patients newly diagnosed with COPD according to their prior history of exacerbations, blood eosinophil count (BEC) and whether maintenance therapy was started. Data were extracted from the Optimum Patient Care Research Database.

73 189 patients were included. 61.9% had no exacerbations prior to diagnosis, 21.5% had 1 moderate, 16.5% had ≥2 moderate and 0.3% had ≥1 severe. 50% were started on maintenance therapy. In patients not started on maintenance therapy the rates of moderate exacerbations in the year after diagnosis in patients with no, 1 moderate, ≥2 moderate and ≥1 severe prior exacerbations were 0.34 (95% CI 0.33–0.35), 0.59 (95% CI 0.56–0.61), 1.18 (95% CI 1.14–1.23) and 1.21 (95% CI 0.73–1.69), respectively. Similar results were seen in patients started on maintenance therapy. BEC did not add significantly to the prediction of future exacerbation risk.

A single moderate exacerbation in the year prior to diagnosis increases the risk of subsequent exacerbations, and more frequent or severe exacerbations prior to diagnosis are associated with a higher risk.

既往加重史用于指导 COPD 的初始维持治疗;然而，这些建议来自已经诊断和治疗的患者。

我们评估了新诊断 COPD 患者在诊断后一年内中度（即用抗生素和/或全身性皮质类固醇治疗）和重度（即住院）恶化的发生率，根据他们先前的恶化史、血嗜酸性粒细胞计数 （BEC） 和是否开始维持治疗。数据从 Optimum Patient Care 研究数据库中提取。

纳入 73 189 例患者。61.9% 的患者在诊断前没有恶化，21.5% 的患者为 1 例中度，16.5% 的患者为 ≥2 例中度，0.3% 的患者为 ≥1 例重度。50% 的患者开始接受维持治疗。在未开始维持治疗的患者中，既往无、1 例中度、≥2 例和 ≥1 例重度既往加重的患者在诊断后一年内的中度恶化率分别为 0.34 （95% CI 0.33-0.35）、0.59 （95% CI 0.56-0.61）、1.18 （95% CI 1.14-1.23） 和 1.21 （95% CI 0.73-1.69）。在开始维持治疗的患者中也观察到类似的结果。BEC 没有显着增加对未来恶化风险的预测。

诊断前一年内单次中度加重会增加后续加重的风险，诊断前更频繁或更严重的加重与更高的风险相关。