A European consortium of researchers has developed a new decision making framework for health professionals which they hope will transform the care of patients with chronic obstructive pulmonary disease (COPD).
The new framework, which classifies the severity of exacerbations of COPD based on three key factors was developed by the Collaboration In COPD Exacerbations (CICERO) funded by the European Respiratory Society, and published in The Lancet Respiratory Medicine on 25 November 2025. It will be presented at the British Thoracic Society Winter Conference on the same day.
Honorary Consultant Respiratory Physician Dr Neil Greening from University Hospitals of Leicester NHS Trust explains: “Exacerbations of COPD remain a major driver of hospital admissions and mortality worldwide. Every time a patient has an acute episode it can set off a cascade of recurrent exacerbations, accelerated lung function decline, and heightened risk of death.
“While this cycle is well documented, the variability in what we observe in these patients has long challenged our ability to predict outcomes and tailor their treatment.
“Traditionally, the severity of an acute exacerbation of COPD has been defined by healthcare use, such as hospital admission or medication use.
“However, this approach overlooks the complex interplay of factors that influence patient deterioration – including baseline health status, event intensity, and any underlying triggers.”
To address this gap, Dr Greening and Dr Aung together with CICERO colleagues from around Europe developed a novel multidimensional framework, the BAt model, designed to predict exacerbation severity and prognostic risk.
The model incorporates three domains: Baseline functional status (B), Acuity of the event (A), and the Trigger (t) driving the episode. By integrating these elements using routinely collected clinical data, the BAt classification offers a structured approach to characterising exacerbations beyond traditional metrics.
Dr Greening continued: “Health professionals could use BAt to guide site-of-care decisions, predict long term outcomes, and tailor treatment strategies to individual patients.
“This may also improve consistency across diverse clinical settings, from primary care to specialist centres.
“As COPD continues to impose a significant burden on patients and health systems, we believe the BAt model represents a promising step toward precision medicine.”
Dr Hnin Aung, Clinical Lecturer at the University of Leicester, and other researchers in London and Belgium are now working to refine and validate the framework, with the hope that it will soon become an integral tool in managing one of the world’s most challenging chronic diseases.
Dr Neil Greening also receives funding from the NIHR Leicester BRC – part of the NIHR and hosted by the University Hospitals of Leicester NHS Trust in partnership with the University of Leicester, Loughborough University and University Hospitals of Northamptonshire NHS Group.
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