The long-term clinical impact of COPD exacerbations: a 3-year observational study (SHERLOCK)

John Haughney, Amanda J. Lee, Mintu Nath, Hana Müllerová, Ulf Holmgren, Enrico de Nigris, Bo Ding

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BACKGROUND AND AIMS: Exacerbations of chronic obstructive pulmonary disease (COPD) drive disease progression and can lead to an accelerated decline in lung function and a burden on healthcare systems. The retrospective, observational cohort Study on HEalthcare Resource utiLization related to exacerbatiOns in patients with COPD (SHERLOCK; D5980R00014) evaluated the associations between exacerbation history and rates of subsequent COPD exacerbations in primary care patients from the National Health Service in Greater Glasgow and Clyde, United Kingdom. METHODS: Patients were stratified into four groups according to exacerbation history in the year before the index date: Group A (no exacerbations), Group B (1 moderate exacerbation only), Group C (1 severe exacerbation only), and Group D (⩾2 moderate or severe exacerbations). The frequencies of moderate and/or severe exacerbations were recorded over 36 months of follow-up and compared with reference Group A, using generalized linear models. RESULTS: Over 36 months of follow-up, the adjusted rate ratios (RRs, 95% confidence interval) of moderate or severe exacerbations relative to Group A were 1.60 (1.53, 1.67), 1.75 (1.50, 2.04), 1.61 (1.54, 1.68), and 3.61 (3.48, 3.74) for Groups B, C, B + C, and D, respectively. Compared with Group A, patients in Group C exhibited an increased rate of moderate (RR, 1.58 (1.35, 1.85)) and severe exacerbations (RR, 3.13 (2.20, 4.46)). CONCLUSION: SHERLOCK highlights that even one moderate exacerbation increases the risk for subsequent exacerbations compared with having no recent prior exacerbations. Reviewing recent exacerbation history to ascertain future exacerbation risk and inform COPD management may reduce hospitalizations and improve patient outcomes.

Original languageEnglish
Article number17534666211070139
Number of pages10
JournalTherapeutic advances in respiratory disease
Early online date14 Feb 2022
Publication statusPublished - 2022

Bibliographical note

Medical writing support, under the direction of the authors, was provided by Sara Cameron, M. Phil., of CMC Connect, McCann Health Medical Communications, funded by AstraZeneca in accordance with Good Publication Practice (GPP3) guidelines.
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by AstraZeneca. Employees of AstraZeneca were involved in the design of the study, interpretation of the data (but not the data collection), in the writing of the report, and in the decision to submit the article for publication.

Data Availability Statement

Remote access to this data set was provided to the study statisticians via Safe Haven. Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data are not available.


  • chronic obstructive pulmonary disease
  • exacerbations
  • risk


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