1. Frequency of self-reported COPD exacerbation and airflow obstruction in five Latin American cities: the PLATINO study M. Montes de Oca 1, C. Talamo 1, D. Moreno 1, A. Menezes 2, R. Perez-Padilla 3, M. Lopez 4, A. Muiño 4, J. Jardim 5, G. Valdivia 6, J. Pertuze 6, R. Halbert 7. 1 Universidad Central de Venezuela, Venezuela; 2 Federal University of Pelotas, Brazil; 3 Institute of Respiratory Diseases, Mexico; 4 Universidad de la República, Uruguay; 5 Federal University of Sao Paulo, Brazil; 6 Pontifícia Universidad Católica de Chile, Chile, 7 UCLA School of Public Health, USA. INTRODUCTION Recurrent exacerbations are common in COPD. Several studies have assessed the frequency of these events and the factors associated with increased exacerbation frequency in selected COPD populations. A number of risk factors for exacerbations have been described: hypercapnia, previous hospital admissions, current smoking, impaired health status, hypoxia, low BMI, systemic inflammation and low FEV 1.The exacerbation frequency seems to increase with disease severity and, patients with GOLD stages 3 and 4 are particularly susceptible to exacerbation. Limited information exists regarding exacerbation frequency in COPD from epidemiologic studies. OBJECTIVE The aims of this study were a) to evaluate the frequency of self-reported exacerbation in COPD and the frequency of severe exacerbations drawn from a multicenter population-based survey conducted in five Latin American cities, and b) to explore the possible factors that influence exacerbation frequency in COPD. METHODS AND MATERIALS Details of the PLATINO methodology have been published (Lancet 2005;366:1875). Post-BD FEV 1 /FVC< 0.70 was used to define COPD. Severity of airway obstruction was assessed by the GOLD stages. For the purpose of this study, COPD exacerbation was self-reported and defined by symptoms (deterioration of breathing symptoms that affected usual daily activities or caused missed work). We examined the proportion of subjects with COPD who reported; any exacerbation; an exacerbation within the 12- months; an exacerbation requiring a doctor visit within the 12-months; and an exacerbation requiring hospitalization within the 12-months. We also examined the number of the exacerbation-related events within the 12-months: any exacerbations; exacerbations requiring a doctor visit; exacerbations requiring hospitalization; and hospital days due to exacerbations. CONCLUSION In summary, the results of this study indicate that among individuals with airflow limitation an important proportion of subjects reported symptom-defined exacerbations with a progressive increase in the proportion as the disease severity increases. No differences in the proportion of subjects with self-reported exacerbation were found among the countries. Dyspnea, prior asthma diagnosis, receiving any respiratory therapy, and more severe obstruction were associated with having a self-reported exacerbation in the past year in COPD subjects. RESULTS Complete interviews were achieved in 5,571 subjects from a total of 6,711 eligible individuals. Spirometry was performed in 5,314 subjects. Among this population there were 759 subjects with post-BD FEV 1 /FVC< 0.70 (451 stage 1, 255 stage 2 and 52 stage 3 & 4) and 4,549 individuals with a post-BD FEV 1 /FVC ≥ 0.70 (no COPD). GOLD Stages Exacerb. within past-yr n Rate/yr Exacerb. requiring a doctor visit within past-yr n Rate/yr Exacerb. requiring hospitalization within past-yr n Rate/yr Hospital days due to exacerb. within past-yr n Rate/yr Stage 1 58 0.13 42 0.09 3 0.007 11 0.02 Stage 2223 0.87 49 0.19 7 0.03 34 0.13 Stage 3 97 2.43 102 2.49 26 0.63 190 4.63 Stage 4 61 6.78 79 7.18 4 0.36 33 3.00 All COPD439 0.58 272 0.36 40 0.05 268 0.35 CountryTotal nPersons with a self- reported exacerbation in the past-yr 95% CI n (persons)%LowHigh Brazil15295.922.059.79 Chile1982311.627.2515.98 Mexico7833.850.007.81 Uruguay174126.902.8710.92 Venezuela157138.284.3112.25 Total759607.916.009.81 VariableOR95% CIp-value LowHigh Current smoker (vs. never)0.450.191.070.071 Former smoker (vs. never)1.440.692.990.333 Wheeze1.960.973.980.061 Dyspnea3.001.277.120.013 Self-reported Asthma diagnosis5.192.4710.88<0.001 Any respiratory therapy (vs. none)3.031.406.560.005 GOLD stage 2 (vs. GOLD 1)1.450.742.880.280 GOLD stages 3 and 4 (vs. GOLD 1)2.271.005.110.049 Table 1. Number of self-reported exacerbation and hospital days due to exacerbation within the past year in COPD subjects, by GOLD stages Table 2. Proportion of COPD subjects and a self-reported exacerbation in the past year, by country Table 3. Factors associated with having a self-reported exacerbation within the past year among COPD subjects Figure 1. Proportion of COPD subjects reporting exacerbation by GOLD severity stages. p<0.0001 p=0.0002 p=0.0001 p=0.007