Table 2 Summary of risk factors for exacerbation events

Prior history of exacerbation

The strongest risk factor for future exacerbations is a history of exacerbations within the last 12 months

Comorbidities

Underlying comorbid diseases including anxiety and depression, asthma, blindness and low vision, dyspepsia, heart failure, hypertension, lung cancer, osteoarthritis, peripheral vascular disease, and prostate disorders are associated with increased risk of exacerbations

COPD severity

and BDR

The risk of exacerbation is significantly higher in patients with severe or very severe airflow limitation and lack of BDR

Eosinophil count

Higher eosinophil count is associated with an increased risk of exacerbations

Quality of life

Poor quality of life at baseline or worsening quality of life over time (measured by SGRQ, CCQ, and CES-D) are associated with an increase in exacerbation risk

Symptomatic burden

Higher symptomatic burden of COPD (CAT ≥ 10 and mMRC ≥ 2) is associated with an increased risk of exacerbations

Smoking

Smoking (former/current) is associated with an increased risk of exacerbations

BMI

Underweight patients (BMI < 18.5 kg/m²) are at higher risk of exacerbations

Age

Older age is associated with an increased risk of exacerbations

Sex

Associations between sex and the risk of exacerbations are variable

Temperature and pollution

Colder temperature and air pollution (NO₂, O₃, CO, and PM10) are associated with an increased risk of exacerbations

Other factors

Low physical activity (decreased 6MWD), elevated inflammatory biomarkers (e.g. C-reactive protein), and certain race/ethnicity/region factors may be associated with an increased risk of exacerbations