{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:17:33Z","timestamp":1785525453973,"version":"3.56.0"},"reference-count":19,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T00:00:00Z","timestamp":1667174400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","award":["D5980R00023"],"award-info":[{"award-number":["D5980R00023"]}],"id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2022,9,10]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Little is known about how lower respiratory tract infections (LRTIs) before chronic obstructive pulmonary disease (COPD) are associated with future exacerbations and mortality. We investigated this association in patients with COPD in England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical Practice Research Datalink Aurum, Hospital Episode Statistics and Office of National Statistics data were used. Start of follow-up was patient\u2019s first ever COPD diagnosis date and a 1-year baseline period prior to start of follow-up was used to find mild LRTIs (general practice (GP) events\/no antibiotics), moderate LRTIs (GP events+antibiotics) and severe LRTIs (hospitalised). Patients were categorised as having: none, 1 mild only, 2+ mild\u2009only, 1 moderate, 2+ moderate and 1+ severe. Negative binomial regression modelled the association between baseline LRTIs and subsequent COPD exacerbations and Cox proportional hazard regression was used to investigate mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 215 234 patients with COPD, increasing frequency and severity of mild and moderate LRTIs were associated with increased rates of subsequent exacerbations compared with no recorded LRTIs (1 mild adjusted IRR 1.16, 95%\u2009CI 1.14 to 1.18, 2+ mild IRR 1.51, 95%\u2009CI 1.46 to 1.55, 1 moderate IRR 1.81, 95%\u2009CI 1.78 to 1.85, 2+ moderate IRR 2.55, 95%\u2009CI 2.48 to 2.63). Patients with 1+ severe\u2009LRTI (vs no baseline LRTIs) also showed an increased rate of future exacerbations (adjusted IRR 1.75, 95%\u2009CI, 1.70 to 1.80). This pattern of association was similar for risk of all-cause and COPD-related mortality; however, patients with 1+ severe LRTIs had the highest risk of all-cause and COPD mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Increasing frequency and severity of LRTIs prior to COPD diagnosis were associated with increasing rates of subsequent exacerbations, and increasing risk of all-cause and COPD-related mortality.<\/jats:p><\/jats:sec>","DOI":"10.1136\/thorax-2022-219039","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T17:20:21Z","timestamp":1667236821000},"page":"760-766","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Frequency and severity of respiratory infections prior to COPD diagnosis and risk of subsequent postdiagnosis COPD exacerbations and mortality: EXACOS-UK health care data study"],"prefix":"10.1136","volume":"78","author":[{"given":"Hannah","family":"Whittaker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clementine","family":"Nordon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Rubino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamsin","family":"Morris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"De Nigris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana","family":"M\u00fcllerov\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-4869","authenticated-orcid":false,"given":"Jennifer K","family":"Quint","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,10,31]]},"reference":[{"key":"2024051320302622000_78.8.760.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0909883"},{"key":"2024051320302622000_78.8.760.2","article-title":"The long-term clinical and economic impact of COPD exacerbations: an observational study (SHERLOCK)","volume":"56","author":"Haughney","year":"2020","journal-title":"Europ Res J"},{"key":"2024051320302622000_78.8.760.3","unstructured":"Vogelmeier CF , Diesing J , Kossack N , et al . COPD exacerbation history and impact on future exacerbations - 8-year retrospective observational database cohort study from Germany."},{"key":"2024051320302622000_78.8.760.4","unstructured":"Whittaker H et al . Frequency and severity of exacerbations of COPD associated with future risk of exacerbations and mortality: a UK routine health care data study."},{"key":"2024051320302622000_78.8.760.5","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2003.008730"},{"key":"2024051320302622000_78.8.760.6","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.57.10.847"},{"key":"2024051320302622000_78.8.760.7","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2005.040527"},{"key":"2024051320302622000_78.8.760.8","unstructured":"NICE . Chronic obstructive pulmonary disease in over 16s: diagnosis and management (ed Excellence, N.I.f.H.a.C.), 2019."},{"key":"2024051320302622000_78.8.760.9","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201710-2029OC"},{"key":"2024051320302622000_78.8.760.10","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S36997"},{"key":"2024051320302622000_78.8.760.11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0151357"},{"key":"2024051320302622000_78.8.760.12","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S117867"},{"key":"2024051320302622000_78.8.760.13","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1093\/jac\/dkz163","article-title":"Antibiotic prescribing for common infections in UK general practice: variability and drivers","volume":"74","author":"Palin","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2024051320302622000_78.8.760.14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0191243"},{"key":"2024051320302622000_78.8.760.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12931-019-1262-0","article-title":"Risk factors for exacerbations and pneumonia in patients with chronic obstructive pulmonary disease: a pooled analysis","volume":"21","author":"Hartley","year":"2020","journal-title":"Respir Res"},{"key":"2024051320302622000_78.8.760.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006171"},{"key":"2024051320302622000_78.8.760.17","doi-asserted-by":"crossref","DOI":"10.1038\/npjpcrm.2016.46","article-title":"Independent effect of prior exacerbation frequency and disease severity on the risk of future exacerbations of COPD: a retrospective cohort study","volume":"26","author":"Marg\u00fcello","year":"2016","journal-title":"NPJ Prim Care Respir Med"},{"key":"2024051320302622000_78.8.760.18","doi-asserted-by":"crossref","unstructured":"Baker M , Jeffers H . Continuity of care in modern day general practice. London: Royal College of General Practitioners, 2016.","DOI":"10.3399\/bjgp16X686185"},{"key":"2024051320302622000_78.8.760.19","unstructured":"Fau FH , Jungblut S . The influence of virus infections on the course of COPD."}],"container-title":["Thorax"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/thorax-2022-219039","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T03:46:33Z","timestamp":1715658393000},"score":1,"resource":{"primary":{"URL":"https:\/\/thorax.bmj.com\/lookup\/doi\/10.1136\/thorax-2022-219039"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,31]]},"references-count":19,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,7,13]]},"published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1136\/thorax-2022-219039"],"URL":"https:\/\/doi.org\/10.1136\/thorax-2022-219039","relation":{},"ISSN":["0040-6376","1468-3296"],"issn-type":[{"value":"0040-6376","type":"print"},{"value":"1468-3296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,31]]}}}