This recommendation reflects the established associations between frequent exacerbations, more rapid decline in lung function 2 and greater impairment of health status. 3 4 Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease with pulmonary and extra-pulmonary manifestations.
This is not surprising, and our data are in line with other studies in which patients with frequent exacerbation were diabetic, female and had more rapid decline in FEV1 from baseline compared with those with infrequent exacerbation [ 10].
Patients with frequent exacerbations have a more rapid decline in lung function, worse quality of life and decreased exercise performance.
Patients experiencing frequent exacerbations have a more rapid decline in lung function [ 11, 14], poorer quality-of-life [ 9], reduced physical activity [ 12] and greater mortality [ 15].
It appears that patients with recurrent exacerbations show a more rapid decline in their physical activity level than stable patients and their functional capacity gradually decreases faster over time [ 11].
Frequent exacerbations are associated with a more rapid decrease in lung function, reduced quality of life, and severe exacerbations often lead to acute hospital admissions.
It should be emphasized that patients with frequent COPD exacerbation have a much more rapid disease progression and related mortality, which merits particular attention to this clinical group [ 201].
Frequent exacerbations result in a more rapid reduction in lung function, with even single episodes having a prolonged negative effect on health status [ 8, 9].
Frequent exacerbations are associated with more rapid decline in FEV1, impaired functional status and HRQoL, worse survival, and increased costs and hospitalizations (50, 54– 54).
Inhaled corticosteroids (ICS) reduced the frequency of acute exacerbations and also reduced the rate of decline in the health status, since frequent exacerbations were associated with a more rapid rate of deterioration in health status [ 13- 15].
