ArticleThe European respiratory journal2021
Should the number of acute exacerbations in the previous year be used to guide treatments in COPD?
Article in The European respiratory journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 43 citations in OpenAlex.
- Development of an artificial intelligence prediction model for moderate-to-severe COPD exacerbations using continuous multiple unobtrusive sensors: protocol of a multicentre prospective observational study.BMJ open respiratory research · 2026Article
- Prediction of Chronic Obstructive Pulmonary Disease Using Machine Learning, Clinical Summary Notes, and Vital Signs: A Single-Center Retrospective Cohort Study in the United States.Advances in respiratory medicine · 2026Article
- Identification of Risk Factors for 30-Day and Frequent One-Year Readmissions in Chronic Obstructive Pulmonary Disease Patients Following Acute Exacerbation.International journal of chronic obstructive pulmonary disease · 2026Article
- Explainable machine learning model for 1-year readmission risk prediction in AECOPD patients: integrating relief feature selection with sample augmentation.BMC infectious diseases · 2025Article
- Impact of dynapenia, presarcopenia and sarcopenia in chronic obstructive pulmonary disease: a prospective cohort study.BMJ open respiratory research · 2025Article
- Impulse oscillometry-defined airway abnormalities as a treatable trait for mild-to-moderate COPD: a prospective cohort study with 3-year follow-up.ERJ open research · 2025Article
- Frequency and severity of COPD exacerbations and future risk of exacerbations and mortality: an observational cohort study in Canada.BMJ open respiratory research · 2025Observational
- Article
- Predictive Value of CCQ and its Subdomains for Hospitalized Exacerbations in Chronic Obstructive Pulmonary Disease: A 3-Year Observational Prospective Study.Journal of general internal medicine · 2025Observational
- Cost effectiveness of a novel swallowing and respiratory sensation assessment and a modelled intervention to reduce acute exacerbations of COPD.BMC pulmonary medicine · 2025Article
- Should all patients with COPD be treated with inhaled triple therapy?ERJ open research · 2025Article
- Is Disease Stability an Attainable Chronic Obstructive Pulmonary Disease Treatment Goal?American journal of respiratory and critical care medicine · 2025Review
- Development and Validation of Machine Learning-Based Models for Prediction of Intensive Care Unit Admission and In-Hospital Mortality in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease.Chronic obstructive pulmonary diseases (Miami, Fla.) · 2024Article
- Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review.Advances in therapy · 2024Review
- Impact of comorbidities in COPD clinical control criteria. The CLAVE study.BMC pulmonary medicine · 2024Article
- Article
- IMplementing Predictive Analytics towards efficient COPD Treatments (IMPACT): protocol for a stepped-wedge cluster randomized impact study.Diagnostic and prognostic research · 2023Article
- Acupuncture as adjunctive therapy for patients with AECOPD: study protocol for a multicenter, randomized controlled trial.Frontiers in public health · 2023Article
- Article
- ACCEPT 2·0: Recalibrating and externally validating the Acute COPD exacerbation prediction tool (ACCEPT).EClinicalMedicine · 2022Article
Corrections and comments
- Commented on by
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundIn contemporary management of chronic obstructive pulmonary disease (COPD), the frequent exacerbator phenotype, based on a 12-month history of acute exacerbation of COPD (AECOPD), is a major determinant of therapeutic recommendations. However, there is considerable debate as to the stability of this phenotype over time.
methodsWe used fundamental principles in time-to-event analysis to demonstrate that variation in the frequent exacerbator phenotype has two major sources: variability in the underlying AECOPD rate and randomness in the occurrence of individual AECOPDs. We re-analysed data from two large cohorts, the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study and the SubPopulations and InteRmediate OutcoMes In COPD Study (SPIROMICS), using a Bayesian model that separated these sources of variability. We then evaluated the stability of the frequent exacerbator phenotype based on these results.
resultsIn both cohorts, the pattern of AECOPDs strongly supported the presence of an individual-specific underlying AECOPD rate which is stable over time (Bayes Factor less than 0.001). Despite this, the observed AECOPD rate can vary markedly year-to-year within individual patients. For those with an underlying rate of 0.8-3.1 events·year
conclusionsWhile the underlying AECOPD rate is a stable trait, the frequent exacerbator phenotype based on observed AECOPD patterns is unstable, so much so that its suitability for informing treatment decisions should be questioned. Whether evaluating AECOPD history over longer durations or using multivariate prediction models can result in more stable phenotyping needs to be evaluated.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.