Impact of stable state symptoms on the future burden of COPD exacerbations

Rationale: There is limited information on how stable state symptoms relate to future exacerbation burden in COPD patients. Methods: The 52-week FLAME study randomised patients with ≥1 exacerbation in past year to indacaterol/glycopyrronium (IND/GLY 110/50µg od) or salmeterol/fluticasone (SFC 50/500µg bid). Patients recorded respiratory symptoms in an electronic diary, enabling detailed characterisation of exacerbations (Figure). In this post-hoc analysis, all patients irrespective of study treatment were divided into groups of low or high baseline dyspnoea burden at run-in, with cut-off at median. Moderate/severe exacerbations were analysed. Results: Patients with low baseline dyspnoea had a lower annualised exacerbation rate (ratio of rates 0.76, 95%CI 0.67, 0.86; p Conclusions: Patients with low baseline dyspnoea experience less frequent COPD exacerbations and reduced exacerbation burden. Future studies of novel exacerbation therapies should target patients with high baseline dyspnoea levels.