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SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM 10:45 AM PREDICTORS OF FREQUENT EXACERBATIONS IN COPD PATIENTS ON TRIPLE THERAPY: CASE CONTROL STUDY FROM INDIA RAHUL SHARMA MD, MBBS, FCCP* DEEPAK TALWAR AND SAGAR THOTE PURPOSE: To identify predictive risk factors and associated comorbidities in “frequent exacerbator” Chronic obstructive pulmonary disease (COPD) phenotype on triple therapy. METHODS: This retrospective case control study included 110 consecutive COPD patients (diagnosed by GOLD guidelines), >18 years of age, on triple therapy (LABA, LAMA and ICS), attending the outpatient department of a tertiary care respiratory centre between 1st September 2016-31st August 2017. Cases/Frequent exacerbator (n1⁄455) had $2 exacerbations while controls (n1⁄455) had one/no exacerbations in the preceding 12 months. All relevant clinical, investigational and treatment data was collected from the medical records and transferred to pre-structured proforma. Univariate and multivariate logistic regression was performed to determine independent clinical and biochemical predictors and associated comorbidities for frequent exacerbations. RESULTS: On multivariate analysis of all variables found to be significantly associated with frequent exacerbations, previous history of exacerbation showed the strongest association (adjusted odds ratio (OR) 8.09) followed by higher MMRC grades of breathlessness(OR 1.345), advanced stages of COPD (OR 1.301) , high eosinophil count (OR 1.03) , low 6-minute walk test distance (OR 0.916) and low serum magnesium (OR 0.025). Low BMI, higher COPD assessment test score, higher rate of oral steroid use and poor pulmonary function test (FEV1, FVC, FEV25-75) were found to be significant only on univariate analysis. Among the comorbidities, gastroesophageal reflux disease (OR 1.13)and pulmonary hypertension(1.08) were significantly associated with frequent exacerbations. Age, gender, active smoking, history of pulmonary TB and comorbidities like osteoporosis, diabetes, hypertension and anemia were not found to be significantly different between the two groups. CONCLUSIONS: Previous history of exacerbation remains the strongest risk factor for frequent COPD exacerbation even in patients on triple therapy. MMRC dyspnea score, high eosinophils counts, poor walk distance covered on 6MWT and low serum magnesium are independent risk factors for frequent exacerbations which can be potential targets for optimization of COPD management. CLINICAL IMPLICATIONS: Despite advances in drug therapy and introduction of triple therapy (LABA, LAMA and ICS), a subset of COPD patients suffer from frequent exacerbations resulting in poor quality of life.This study identifies various nonmodifiable (history of previous exacerbation, GOLD staging, MMRC staging) and modifiable (high eosinophil count, low magnesium) risk factors for frequent exacerbations in COPD. Hence thorough evaluation for these risk predictors and appropriate personalized intervention should be included in routine management of COPD patients. DISCLOSURES: No relevant relationships by Rahul Sharma, source1⁄4Web Response no disclosure on file for DEEPAK TALWAR; no disclosure on file for Sagar Thote; DOI: http://dx.doi.org/10.1016/j.chest.2019.08.1484 Copyright a 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. 694A [ 1 5 6 # 4 S CHES T OC TO B E R 2 0 1 9 ]