Young adult patients with chronic obstructive pulmonary disease and a history of asthma may face nearly triple the risk of moderate-to-severe exacerbations, according to a recent study’s findings. 

In the study, published in BMJ Open Respiratory Research, investigators examined risk factors for exacerbations and disease progression in young adult patients with chronic obstructive pulmonary disease (COPD), identifying asthma, emphysema, and high eosinophil counts as significant factors. The retrospective study from a Seoul National University Hospital and Boramae Medical Center cohort included 342 patients aged 20 to 50 years, with a median follow-up period of 64 months. Primary outcomes focused on moderate-to-severe exacerbation rates, whereas secondary outcomes examined early initiation of regular inhalation therapy and rates of postbronchodilator forced expiratory volume in one second (FEV₁) decline.

During follow-up, 41.5% of the patients experienced moderate-to-severe exacerbations. In multivariable analyses, significant risk factors included a history of asthma (adjusted hazard ratio [HR] = 2.999, 95% confidence interval [CI] = 2.074–4.335), emphysema (adjusted HR = 1.951, 95% CI = 1.331–2.960), blood eosinophil count > 300/µL (adjusted HR = 1.469, 95% CI = 1.038–2.081), and lower FEV₁ (adjusted HR = 0.979, 95% CI = 0.970–0.987). Initiation of regular inhalation therapy within 3 years of diagnosis was more common in patients with asthma, sputum production, elevated eosinophil counts, reduced FEV₁, and low diffusing capacity of the lung for carbon monoxide (DL_CO).

Factors associated with accelerated FEV₁ decline included increasing age, female sex, history of tuberculosis, presence of sputum, low baseline FEV₁, and reduced DL_CO, with 33% of the patients demonstrating rapid FEV₁ decline. The findings highlighted the importance of identifying high-risk factors in young adults with COPD such as respiratory comorbidities, elevated eosinophil levels, and impaired lung function, which are associated with an increased likelihood of exacerbations and disease progression.

Full disclosures can be found in the published study.