Identifying patients with mild-to-moderate COPD who require intensified initial treatment to control annualized clinically important deterioration

BACKGROUND: The chronic obstructive pulmonary disease (COPD) guidelines recommend selecting initial treatment based on the severity of respiratory symptoms or exacerbation history. However, some patients still experience clinically important deterioration (CID) despite this strategy. Therefore, we aimed to identify the risk factors to guide initial treatment, focusing on mild-to-moderate COPD patients whose annualized CID cannot be controlled by a single-bronchodilator. METHODS: and CAT scores. The logistic regression analysis was adapted to detect the risk factors. The risk of annualized CID was evaluated using the incidence risk ratio (IRR) for patients with risk factors. RESULTS: :FVC ≤ 60% (OR = 1.73, 95%CI: 1.06-2.84) and smoking pack-years ≥50 (OR = 1.95, 95%CI: 1.11-3.41) were associated with higher risk of experiencing annualized CID. The IRR of annualized CID was increased with more risk factors at baseline. CONCLUSION: Patients with more prominent airflow limitation and higher smoking pack-years warrant intensified initial treatment to control their annualized CID.