A 63-year-old man with a 40-pack-year smoking history and kn…
A 63-year-old man with a 40-pack-year smoking history and known chronic obstructive pulmonary disease (COPD) returns for routine follow-up. Over the past 12 months, he has had 3 exacerbations—each treated with systemic corticosteroids and antibiotics; 2 required a brief hospital admission. He now complains of increased dyspnea on minimal exertion (modified Medical Research Council Dyspnea Scale grade 3) and reports a chronic productive cough. Which of the following in this patient’s history is known to be the strongest predictor of future exacerbation risk?