Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of this prevalent and devastating condition. This review provides a concise, state of the art summary on prevention and management of exacerbations. Considerable new data underpins evidence in support of many preventative interventions, pharmacological and non-pharmacological, that are now available. Challenges remain in developing new approaches, and delivering those that already exist to the right patient at the right time. Management of an exacerbation remains stepwise according to clinical severity, but there is now additional focus on addressing comorbidities and taking the opportunity at acute events to optimise preventative strategies for the future. Ultimately, exacerbations are heterogeneous events in a heterogeneous disease, and an individualised approach is paramount.
Highlights
Affecting 10% of the population over the age of 40 years [1], the burden of chronic obstructive pulmonary disease (COPD) has reached epidemic proportions
This review provides a critical summary of present exacerbation therapies and aims to update the reader on recent developments in the treatment and prevention of exacerbations in COPD
Whilst pulmonary rehabilitation has an important role in preventing hospitalisations in COPD, http://www.biomedcentral.com/1741-7015/7/40 concept is complicated by the data referred to above suggesting that antibiotic treatment at one exacerbation may affect the timing of subsequent events [28]
Summary
Affecting 10% of the population over the age of 40 years [1], the burden of chronic obstructive pulmonary disease (COPD) has reached epidemic proportions. Whilst pulmonary rehabilitation has an important role in preventing hospitalisations in COPD (discussed below), http://www.biomedcentral.com/1741-7015/7/40 concept is complicated by the data referred to above suggesting that antibiotic treatment at one exacerbation may affect the timing of subsequent events [28]. Perhaps the greatest remaining challenge is to establish which patient will benefit from which combination of approaches, though there is still the need for novel interventions as current approaches are incompletely effective It has been known for some time that the three main classes of inhaled medication in COPD (corticosteroids, and long-acting anticholinergic and β2 agonist bronchodilatiors) all reduce exacerbation frequency, there is compelling new data with regard to these drugs. A recent study has suggested that domiciliary NIV for COPD patients with hypercapnoeic respiratory failure may improve survival [51], but robust data in this field with regard to exacerbations remain to be produced
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