Background: COPD exacerbations are associated with rapid FEV1 decline, poor quality of life and greater mortality. We aimed to characterise exacerbation-like events among young adult smokers.
Methods: Imperial College London site members of the Early COPD cohort (age 30-45 yrs, tobacco smokers with >10 pack-years and ?normal? (>80% predicted) FEV1) (NCT03480347) underwent 6-month reviews when stable. When acute respiratory symptoms developed, they completed diary cards and lung function measurements. Exacerbation sputum viral PCR was performed.
Results: From 179 participants [mean age 39 (IQR 36-43), 64% male, mean 16 (IQR 12-22) pack-years, mean FEV1 104% predicted], followed for 24 months, 74 with an exacerbation reported coryzal symptoms (76%), breathlessness (39%), cough (58%) and/or increased sputum production (64%), lasting median 8 days.The commonest detected virus was Rhinovirus (Table1). Mean FEV1 exacerbation-associated reduction from baseline was 249ml. Incomplete FEV1 recovery (>20mls) occurred in 18/74(24%) at 6 weeks follow-up. Greater FEV1 reduction occurred in virus-positive relative to virus-negative events (-374 vs. -274ml, P=0.01).
Conclusion: Young adult smokers with normal baseline spirometry experience viral ?exacerbations? in respiratory symptoms accompanied by substantial, and potentially persistent, decrements in FEV1. These may be key targets for therapeutic intervention.
| Organism | Number (%) |
| Virus | 36(48.7%) |
| Rhinovirus | 19(28.8%) |
| Seasonal coronavirus | 6(9.1%) |
| Influenza | 3(4.6%) |
| Metapneumovirus | 2(3.0%) |
| Adenovirus | 2(3.0%) |
| Enterovirus | 2(3.0%) |
| RSV | 1(1.5%) |
| Bocavirus | 1(1.5%) |
| Bacteria | 2(3.0%) |
| S Aureus | 1(1.5%) |
| S Pneumoniae | 1(1.5%) |
| Not detected | 30(45.5%) |
Table 1: Aetiology of 'exacerbations'