Abstract
Patients with chronic obstructive pulmonary disease (COPD) often suffer acute exacerbations (AECOPD) and community-acquired pneumonia (CAP), named nonpneumonic and pneumonic exacerbations of COPD, respectively. Abnormal host defense mechanisms may play a role in the specificity of the systemic inflammatory response. Given the association of this aspect to some biomarkers at admission (e.g., C-reactive protein), it can be used to help to discriminate AECOPD and CAP, especially in cases with doubtful infiltrates and advanced lung impairment. Fever, sputum purulence, chills, and pleuritic pain are typical clinical features of CAP in a patient with COPD, whereas isolated dyspnea at admission has been reported to predict AECOPD. Although CAP may have a worse outcome in terms of mortality (in hospital and short term), length of hospitalization, and early readmission rates, this has only been confirmed in a few prospective studies. There is a lack of methodologically sound research confirming the impact of severe AECOPD and COPD + CAP. Here, we review studies reporting head-to-head comparisons between AECOPD and CAP + COPD in hospitalized patients. We focus on the epidemiology, risk factors, systemic inflammatory response, clinical and microbiological characteristics, outcomes, and treatment approaches. Finally, we briefly discuss some proposals on how we should orient research in the future.
Highlights
Patients with chronic obstructive pulmonary disease (COPD) often suffer acute exacerbations (AECOPD) and community-acquired pneumonia (CAP), named nonpneumonic and pneumonic exacerbations of COPD, respectively
Relevant publications were selected based on the following search terms: “chronic obstructive pulmonary disease” in combination with “exacerbation,” “pneumonia,” “risk factor,” “inflammation,” “biomarkers,” “clinical,” “hospitalization,” “microbiology,” “pathogens,” “acute respiratory failure,” “intensive care,” “critical,” “outcome,” “mortality,” “prognosis,” and “survival.” We restricted the search to human adults
This study showed that patients with COPD and CAP have lower serum levels of tumor necrosis factor-α (TNF-α) and cytokines (IL-1 and IL-6) at hospital admission compared with those with CAP only
Summary
We searched English language publications on PubMed, focusing on the past 10 years. Relevant publications were selected based on the following search terms: “chronic obstructive pulmonary disease” in combination with “exacerbation,” “pneumonia,” “risk factor,” “inflammation,” “biomarkers,” “clinical,” “hospitalization,” “microbiology,” “pathogens,” “acute respiratory failure,” “intensive care,” “critical,” “outcome,” “mortality,” “prognosis,” and “survival.” We restricted the search to human adults.
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