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Background: Individual susceptibility to exacerbations in chronic obstructive pulmonary disease (COPD) is likely influenced by genetic factors; however, most such variance is unexplained. We hypothesised that β 2 -adrenergic receptor genotypes, Gly16Arg (rs1042713, c.46G>A) and Gln27Glu (rs1042714, c.79C>G) influence risk of severe exacerbations in COPD., Methods: Among 96 762 individuals in the Copenhagen General Population Study, we identified 5262 with COPD (forced expiratory volume in one second divided by forced vital capacity, FEV 1 /FVC, below 0.7, FEV 1 less than 80% of predicted value, age above 40 years and no asthma) who had genotyping performed. Severe exacerbations were defined as acute admissions due to COPD during 5 years of follow-up (mean 3.4 years). 923 individuals with COPD diagnosed similarly in the Copenhagen City Heart Study (CCHS) were used for replication analyses., Results: We recorded 461 severe exacerbations in 5262 subjects. The HRs for severe exacerbations were 1.62 (95% CI 1.30 to 2.03, p=0.00002) for 16Gly/Arg heterozygotes and 1.41 (1.04 to 1.91, p=0.03) for 16Arg homozygotes, compared with 16Gly homozygotes. HRs were 1.35 (1.03 to 1.76, p=0.03) for 27Gln/Glu heterozygotes and 1.49 (1.12 to 1.98, p=0.006) for 27Gln homozygotes, compared with 27Glu homozygotes. Similar trends were observed in the CCHS. Among 27Gln homozygotes only, HRs were 5.20 (1.81 to 14.9, p=0.002) for 16Gly/Arg heterozygotes and 4.03 (1.40 to 11.6, p=0.01) for 16Arg homozygotes, compared with 16Gly homozygotes., Conclusion: Common β 2 -adrenergic receptor genotypes influence risk of severe exacerbations in COPD, potentially mainly by genetic influence of the 16Arg allele in rs1042713., Competing Interests: Competing interests: TSI has received a fee for speaking from AstraZeneca. JV has received honoraria from Chiesi, GlaxoSmithKline, Almirall, AstraZeneca, Boehringer-Ingelheim, and Novartis for consulting and for presenting at meetings and symposia, none of it related to the topic of this study. LR and JLM: none to declare. PL has received honoraria from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis, Teva, and GlaxoSmithKline for presenting at meetings and symposia, none of it related to the topic of this study. BGN: none to declare., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The information on night-time symptoms in chronic obstructive pulmonary disease (COPD) is sparse. We investigated the prevalence of night-time dyspnoea in 6616 individuals with COPD recruited from the general population in the Copenhagen area, Denmark, and described characteristics and prognosis of subjects with this symptom. The prevalence of night-time dyspnoea was 4.3%: 2.1% in Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A, 12.9% in GOLD B, 2.6% in GOLD C and 16.3% in GOLD D. Compared with individuals without night-time dyspnoea, those with night time dyspnoea had lower forced expiratory volume in 1 s, higher daytime dyspnoea scores (modified Medical Research Council scale) and more wheezing, more often had chronic mucus hypersecretion, ischaemic heart disease and atrial fibrillation, and more often reported stress, nervousness and tiredness. After adjustment for age and sex, the presence of night-time dyspnoea was associated with future COPD exacerbations (hazard ratio (HR) 2.3, 95% CI 1.7-3.0), hospital admissions due to COPD (HR 3.2, 95% CI 2.3-4.4) and mortality (HR 1.7, 95% CI 1.2-2.3). Prevalence of night-time dyspnoea in COPD increases with disease severity according to both spirometric and clinical GOLD classification, and is associated with presence of daytime respiratory symptoms and cardiac comorbidities. Night-time dyspnoea is a significant predictor of poor prognosis in individuals with COPD., (©ERS 2014.)

Introduction: Our goal was to estimate the number of individuals with chronic obstructive pulmonary disease (COPD) in the Capital Region of Denmark and the need of resources required to implement the regional management programme for COPD., Material and Methods: We examined a total of 45,970 participants from the Copenhagen General Population Study (CGPS) using spirometry and a questionnaire., Results: The prevalence of spirometrically defined COPD among individuals older than 40 years of age was 15%, corresponding to 120,000 citizens in the Region. The number of individuals with moderate COPD (forced expiratory volume in one second (FEV1): 50-80% of predicted value) was estimated to approx. 51,000 (6.4%), whereas at least 10,000 (1.3%) were expected to have severe or very severe COPD (FEV1 < 50% of predicted value). Our estimates indicate that more than 26,000 individuals with moderate, severe or very severe COPD in the Region are smokers and that more than 19,000 qualify for physical training. We estimated that approx. 4,000 individuals with severe COPD were not treated with any inhaled medication., Conclusion: The Capital Region of Denmark needs to allocate substantial resources into early detection, rehabilitation and medical treatment of individuals with COPD in order to comply with the intentions of the Region's own management programme for COPD., Funding: The present analyses were sponsored by a grant from the Danish Ministry of Health. The CGPS was supported by the Copenhagen County Foundation, the Danish Medical Research Council and the Boserup Foundation., Trial Registration: not relevant.

Introduction: COPD is one of the leading causes of death worldwide. No recent prevalence study has been carried out in Denmark, but it is estimated that approximately 200,000 Danes have COPD. The aim of this study was to determine the prevalence of COPD in Copenhagen using data from the 4th examination of The Copenhagen City Heart Study (CCHS from 2001-2004) and to estimate the total number of COPD patients in Denmark., Materials and Methods: 6,238 people participated in the 4th examination of CCHS. We selected all participants aged 35 years or older with adequate information regarding smoking habits and lung function for the final prevalence analyses (n = 4,908). COPD staging was done according to the GOLD and ERS/ATS criteria. We received information regarding the Danish population from The National Bureau of Statistics Denmark., Results: The prevalence of COPD in the 4th CCHS increased with age and was higher among males than females. The total number of Danes with COPD is estimated to 430,000, 270,000 of whom have clinically important COPD (GOLD 2-4) and 40,000 have severe COPD (GOLD 3-4)., Conclusion: The prevalence of COPD in Denmark is higher than previously anticipated. The 40,000 patients with severe COPD are in immediate need of relevant medical treatment and rehabilitation. Danish society also needs to exert a substantial effort comprising early detection, prophylaxis and relevant treatment for the 230,000 persons with moderate COPD in order to prevent disease progression.