Marjan Kerkhof,1 Daryl Freeman,2 Rupert Jones,3 Alison Chisholm,4 David B Price1,5 On behalf of the Respiratory Effectiveness Group 1Research in Real-Life, Cambridge, 2Mundesley Medical Centre, Norfolk, 3Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, 4Respiratory Effectiveness Group, Cambridge, 5Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK Purpose: Acute COPD exacerbations account for much of the rising disability and costs associated with COPD, but data on predictive risk factors are limited. The goal of the current study was to develop a robust, clinically based model to predict frequent exacerbation risk.Patients and methods: Patients identified from the Optimum Patient Care Research Database (OPCRD) with a diagnostic code for COPD and a forced expiratory volume in 1 second/forced vital capacity ratio