Background: Lack of insight into the interplay of COPD and common comorbidities complicates disease management.

Aim: Exploring patterns of acute COPD exacerbations (AECOPDs) and comorbid flare-ups.

Methods: One-year daily symptom data (ERJ 2019 54:1802134) were analysed in patients with ?1 AECOPD and/or comorbid flare-up. Patterns of AECOPDs and flare-ups of chronic heart failure (CHF), anxiety (ANX) and depression (DEP) were identified, based on predominance of AECOPDs or comorbid flare-ups and their overlap.

Results: Out of 90 patients (68±9 years; comorbid CHF (42%), ANX (38%), DEP (49%)), 49 had both AECOPDs and comorbid flare-ups, which occurred mostly simultaneously in 33 patients.

In 26 patients with AECOPDs and CHF flare-ups, the following patterns were identified: predominantly AECOPDs (n=15) (as in Fig. 1A), predominantly CHF flare-ups (n=5) (Fig. 1B), no clear predominance (n=6). In 16 patients, AECOPDs and CHF flare-ups mostly occurred simultaneously (Fig. 1C), whilst in 10 patients, AECOPDs and CHF flare-ups were seen separately (Fig. 1D).

In 15 out of 24 patients with ANX and DEP flare-ups, these occurred simultaneously, of whom in 13 along with AECOPDs (Fig. 1E). In 9 patients, single ANX or DEP flare-ups were seen, of whom in 6 separately from AECOPDs (Fig. 1F).

Conclusions: Patients show a variety of AECOPD and comorbid flare-up patterns. If within-patient patterns are recognised, personalised disease management can be improved.