P13 Seasonal variation in exacerbation risk following severe AECOPD

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Introduction Admission to hospital with a severe exacerbation of COPD (AECOPD) is associated with an increased risk of further exacerbations, readmission and death. Seasonality can affect exacerbation phenotype (Aung et al, 2024), but it remains unclear how season of onset affects ongoing risk following severe AECOPD. Methods COPD-HELP was a single-centre, double-blind, randomised, placebo-controlled trial that recruited 238 participants during hospitalisation for AECOPD and allocated them 1:1 to mepolizumab or placebo for 48 weeks. All participants had an eosinophil count ≥300 cells/µL on at least one occasion in the prior 12 months, were established on inhaled corticosteroids and current or ex-smokers. Full details are published elsewhere. (Flynn et al., 2025) For this analysis, 119 participants on placebo were included. Exacerbation rates were analysed based on an individual’s season of entry into the trial.. Entry into trial occurred within a week of a severe AECOPD for all participants. Exacerbation rates were calculated as the total number of exacerbations per participant, offset by time in trial. A linear regression model was fitted, using season of study enrolment as the primary predictor variable and exacerbation rate in the preceding 12 months as a covariate Results Adjusted annual exacerbation rates varied significantly by season, with the highest rate in summer (adjusted mean 5.76, 95% CI, 5.33 – 6.19), followed by autumn (4.02, 95% CI, 3.47 – 4.57), spring (3.98, 95% CI, 3.28 – 4.69), and lowest in winter (3.48, 95% CI, 2.92 – 4.04). This represents a relative increase of 65% following an exacerbation in summer compared to winter. Conclusions In an eosinophilic COPD population, severe exacerbations in summer were associated with a higher rate of exacerbations in the following year than those in any other season. This group may be particularly susceptible to environmental exposures such as increased pollen levels, pollution index or other seasonal allergens. Greater understanding of seasonal dynamics and mechanisms driving recurrent exacerbations could play a role in risk reduction and post exacerbation care and guidance.

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