Chronic obstructive pulmonary disease (COPD) is a common progressive lung disease, affecting 1.2 million people in the UK (1). COPD is projected to be the third most common cause of mortality worldwide in 2020 (2). People with COPD are at higher risk of cardiovascular disease, and up to one third of patients in this group will die from cardiovascular disease (3). Cardiovascular disease is therefore an important target area for reducing mortality in people with COPD. Patients with COPD often experience worsening in their symptoms called acute exacerbations of COPD (AECOPD), which are often triggered by infections. It has been suggested that shortly after AECOPD there is a higher chance of having a stroke, but this hypothesis has not been confirmed yet. In this study, we will investigate if people with COPD are more likely to have a stroke following AECOPD. We will also investigate factors which might modify this risk. The results of this study will be used to inform our understanding of cardiovascular disease in people with COPD and may be used to inform future interventions for reducing the risk of stroke in people with COPD.
We will use CPRD linked with HES and ONS to conduct a self-controlled case series to investigate the risk of stroke in people with COPD during and shortly after periods of exacerbation compared to stable periods. The self-controlled case series method allows the effects of transient exposures on events to be investigated. A major advantage of this method is that fixed confounders are controlled for implicitly such as genetics, gender and socio-economic factors (4). We will investigate whether there is an increased risk of stroke associated with acute exacerbations of COPD (AECOPD) and investigate the length of the period of potential increased risk. We will also investigate whether severity of AECOPD, previous frequency of exacerbations, respiratory drugs, cardiovascular drugs and influenza vaccination modifies any risk of stroke associated with AECOPD. The findings from this study will be used by clinicians to understand when their COPD patients are at highest risk of stroke. The findings may also inform future interventions to reduce this risk.
Incident stroke
Jennifer Quint - Chief Investigator - Imperial College London
Kieran Rothnie - Corresponding Applicant - GlaxoSmithKline Services Unlimited (UK)
Olivia Connell - Collaborator - Imperial College London
HES Admitted Patient Care;ONS Death Registration Data