Abstract
BACKGROUND: Disease stability is an achievable goal in chronic obstructive pulmonary disease (COPD) management. However, the clinical implications of disease stability in patients with COPD remain unclear. METHODS: We conducted a single-center retrospective cohort study using the electronic medical records of treated patients with symptomatic COPD. Patients who had newly initiated inhaler therapy with long-acting β2-agonist/long-acting muscarinic antagonist (LABA/LAMA) or inhaled corticosteroid/LABA/LAMA combinations were included. Disease stability was defined over a one-year assessment period as meeting all of the following criteria: (1) symptom stability; (2) no moderate or severe exacerbations; and (3) no rapid decline in lung function. The outcomes included acute exacerbations and all-cause mortality. RESULTS: Of the 725 screened patients, 405 were eligible for inclusion in the study. Among them, 158 (39.0%) achieved disease stability. The proportions of patients who met each criterion were 70.4% for symptom stability, 63.7% for no exacerbations, and 71.4% for a non-rapid lung function decline. Only 5.9% met none of these criteria. During the follow up duration of median 62 (interquartile ranges, 30-90) months, disease stability was significantly associated with a reduced risk of moderate-to-severe (adjusted hazard ratio [aHR] 0.521, 95% confidence interval [CI] 0.392-0.692) and severe (aHR 0.393, 95% CI 0.279-0.553) exacerbations after adjusting for confounders. It was also associated with a decreased mortality risk (aHR 0.345, 95% CI 0.135-0.883). CONCLUSION: Disease stability was associated with a lower risk of exacerbation and mortality, suggesting its potential role as a treatment target and outcome measure for COPD.