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Table 4 COPD exacerbationsa

From: Variability of the chronic obstructive pulmonary disease key epidemiological data in Europe: systematic review

Exacerbation definition group

(study typeb)

Country (sample size)

Classification

(stage of COPD)

Mean number of

exacerbations per patient

and per yearc

Treatment

Treatment

    

   Burge et al., 2003 [58]d (CT)

United Kingdom (524)

GOLD (2 or 3)

1.6-1.7

Placebo

   

1.1-1.4

Fluticasone propionate

   Calverley et al., 2003 [59] (CT)

25 countries (1,974)

GOLD (2 or 3)

1.3

Placebo

   

1.0

Salmeterol

   

1.0

Fluticasone

   

1.0

Salmeterol and fluticasone

   Jones et al., 2003 [60]d (CT)

United Kingdom (751)

GOLD (1 or 2)

1.0

Placebo

   

0.7

Fluticasone

  

GOLD (3 or 4)

1.7

Placebo

   

1.5

Fluticasone

   Andersson et al., 2002 [61] (CT)

Sweden (191)

GOLD/BTS

1.2

 

   Burge et al., 2000 [62]d (CT)

United Kingdom (751)

GOLD (2 or 3)

1.9 (2.6)

Placebo

   

1.4 (1.9)

Fluticasone

Symptoms

    

   Effing et al., 2009 [63] (CT)

Netherlands (142)

GOLD (2 or 3)

3.5 (2.7)

 

   Worth et al., 2009 [64]e (CT)

Germany (220)

GOLD (3 or 4)

0.9

Placebo

   

0.4

Cineole

   Schermer et al., 2009 [65] (CT)

Netherlands (286)

GOLD (1-3)

0.7

Placebo

   

0.9

Fluticasone

   

1.0

N-acetylcysteine

   O'Reilly et al., 2006 [66] (OS)

United Kingdom (309)

GOLD (1 or 2)

2.2 [1.9-2.7]

Symptom-defined

   

2.3 [2.0-2.8]

Healthcare-defined

  

GOLD (3 or 4)

2.5 [2.1-2.9]

Symptom-defined

   

3.2 [2.8-3.7]

Healthcare-defined

   Wilkinson et al., 2006 [67] (OS)

United Kingdom (74)

GOLD (2 or 3)

2.5 {1.3-3.8}

 

   Donaldson et al., 2003 [68] (OS)

United Kingdom (132)

GOLD (2 or 4)

2.5 {1.3-3.9}

 

   Seemungal et al., 2000 [69] (OS)

United Kingdom (101)

GOLD (2 or 4)

2.4 {1.3-3.8}

 

Treatment and symptoms

    

   Seemungal et al., 2008 [70] (CT)

United Kingdom (109)

GOLD (2 or 3)

2.0

Placebo

   

1.0

Erythromycin

   Tashkin et al., 2008 [71] (CT)

37 countries (5,993)

GOLD (2-4)

0.8

Placebo

   

0.7

Tiotropium

   Calverley et al., 2008 [72] (CT)

11 countries (911)

GOLD (2 or 3)

1.0

Placebo

   

0.6

Mometasone furoate

   Wedzicha et al., 2008 [73] (CT)

20 countries (1,323)

GOLD (3 or 4)

1.3

SFC

   

1.3

Tiotropium

   Dusser et al., 2006 [74] (CT)

France (1,010)

GOLD (1 or 2)

2.0

Placebo

   

1.2

Tiotropium

  

GOLD (3 or 4)

1.8

Placebo

   

2.7

Tiotropium

   Soler-Cataluña et al., 2005 [55] (OS)

Spain (304)

GOLD (1)

(75, 25, 00)f

 
  

GOLD (2)

(60, 35, 05)f

 
  

GOLD (3)

(56, 32, 12)f

 
  

GOLD (4)

(34, 40, 26)f

 

   Oostenbrink et al., 2004 [75] (CT)

Netherlands and Belgium (519)

GOLD (1-4)

1.0 (0.1)

Placebo

   

0.7 (0.1)

Fluticasone

   Brusasco et al., 2003 [76] (CT)

18 countries (1,207)

GOLD (2 or 3)

1.5

Placebo

   

1.2

Salmeterol

   

1.1

Tiotropium

Model

    

   Borg et al., 2004 [77] (M)

Netherlands

GOLD (1)

(0.05, 0.07, 0.01)g

 
  

GOLD (2)

(1.01, 1.31, 0.14)g

 
  

GOLD (3)

(1.06, 1.45, 0.17)g

 
  

GOLD (4)

(1.47, 1.72, 0.33)g

 

Not defined

    

   Detournay et al., 2004 [53] (OS)

France (255)

Moderate

1.7

 
  

Moderate to

1.5

 
  

severe

  
  

Severe

2.0

 
  1. aCriteria used to define exacerbations were symptoms, treatment, symptoms and treatment or model-based. COPD stages are defined according to GOLD [53, 55, 59–62, 66–69, 74–77, 90], BTS [61] and SPLF [53] criteria. bStudy type reported as CT, clinical trial; OS, observational study; M, model. cMean numbers of exacerbations per person and per year were reported in various ways: mean exacerbation or mean exacerbation (±SD) or mean exacerbation {min-max} or [95% confidence interval]. dThese three articles concern the same patients (the Inhaled Steroids in Obstructive Lung Disease trial). eThese estimates are based on 6 months of follow-up. The mean exacerbation in both groups during the previous year was 3.2. fThis article does not give the mean number of exacerbations but the proportion of patients who had, respectively, no acute exacerbations, one, two or three or more. gMean number of exacerbations per person and per year reported separately for mild, moderate and severe exacerbations. Abbreviations used: COPD, chronic obstructive pulmonary disease; BTS, British Thoracic Society classification; GOLD, Global Obstructive Lung Disease classification; SPLF, Société de Pneumonologie de Langue Française classification; SFC, salmeterol and fluticasone propionate (anti-inflammatory drug combination); ISOLDE, the Inhaled Steroids in Obstructive Lung Disease trial.