TY - JOUR T1 - Stability of the frequent exacerbator – A Danish nationwide register-based study JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2016.OA1995 VL - 48 IS - suppl 60 SP - OA1995 AU - Mette Reilev AU - Jesper Lykkegaard AU - Anders Halling AU - Jørgen Vestbo AU - Jens Søndergaard AU - Anton Pottegård Y1 - 2016/09/01 UR - http://erj.ersjournals.com/content/48/suppl_60/OA1995.abstract N2 - Background and aim The existence of a stable frequent exacerbator phenotype constitutes the basis of most treatment guidelines in chronic obstructive pulmonary disease (COPD). We aim to investigate the stability of the frequent exacerbator within a 10-year follow-up period in a population-based study.Methods We conducted a nationwide register-based study with a 10-year follow-up period of patients with COPD and at least one medically treated exacerbation in 2003, defined as a short-term treatment with oral corticosteroids or a hospitalization due to COPD. First, we categorized the population as frequent, infrequent and non-exacerbators each subsequent year and quantified the flow between categories. Second, we calculated the proportion of frequent exacerbators in 2003 that remained in this category throughout a 3- and 5-year follow-up period.Results We identified 19,752 COPD patients with exacerbations in 2003; 30% were frequent exacerbators. Overall, a large proportion of exacerbators in 2003 were non-exacerbators in the following years (60% in 2004 increasing to 68% in 2012). Approximately half of those categorized as frequent exacerbators in one year were either infrequent- or non-exacerbators in the subsequent year. This pattern was stable throughout follow-up. A minority of frequent exacerbators in 2003 stayed in this category throughout a 3- and 5-year follow-up period (11% and 6%, respectively), and a substantial proportion (43%) did not have further years as frequent exacerbators.Conclusions The concept of a stable frequent exacerbator phenotype appears inapplicable in the general population. This finding challenges current management of COPD patients in general practice. ER -