Severe exacerbations and mortality in COPD patients: A retrospective analysis of the database of the Hungarian National Health Insurance Fund.

INTRODUCTION:COPD is one of the most common pulmonary diseases and one of the leading causes of death worldwide. Exacerbations of COPD include acute worsening that could lead to hospitalization and death. In this study, our objective was to investigate the natural course of moderate and severe exacerbations (SAE) and mortality in the Hungarian population in the past decade. METHODS:A retrospective financial database analysis was performed to examine the risk of additional SAEs and death after the first ever SAE in COPD patients, using the financial database of the Hungarian National Health Insurance Fund (NHIF). Patients were enrolled between 2009.01.01. and 2019.12.31. if they had received at least one inhaled drug (LABA, LAMA, ICS or SABA/SAMA) and had been hospitalized for a COPD exacerbation (ICD-10 code J44). RESULTS:A total of 63,037 patients with COPD were enrolled after their first SAE. Of them, 27,095 patients suffered at least one subsequent SAE, and 32,120 patients died during the 10-year follow-up. The median survival was 4.7 years. The risk of subsequent hospitalizations increased significantly after each SAE, with hazard ratios ranging from 1.65 to 5.01. The risk for mortality was increased after each SAE, but did not increase further with the number of SAEs. Moreover, the risk for subsequent SAE and death increased with moderate exacerbations; however, this risk did not increase further with each event. CONCLUSIONS:Despite a relevant improvement in COPD treatment, the natural course of exacerbations remained unchanged. This result highlights the importance of preventing exacerbations and the need for more research to better predict them.