Chronic obstructive pulmonary disease (COPO) is the only leading cause of death with a rising prevalence It is the fourth leading cause of death in the United States and accounts for approximately 500,000 hospitalizations and 110,000 deaths for exacerbations each year. Patients who are admitted to the intensive care unite (ICU) for COPO exacerbations have an in-hospital mortality of 24%.1-4 It has been estimated that by the year 2020, COPO will be fifth among the conditions that will be the most burden to society.5Morbidity and mortality due to COPO vary dramatically between industrialized countries. These variations have been attributed to different exposures to risk factors such as tobacco, atopy, occupational hazards, genetic factors, and air pollution. Outside the United States, COPO has had a similar impact on health and mortality throughout the developed and underdeveloped world, and many of the important issues surrounding COPO in the United States applyelsewhere. 6
DefinitionsThe term COPD, as recommended by the American Thoracic Society, must be applied to patients who have chronic bronchitis and/or emphysema with significant airflow limitation that does not change significantly over a period of several months of observation, thus distinguishing these patients from those with asthma. 5New definitions of acute COPO exacerbation (AECOPO) have been suggested, but the one widely accepted is generally considered as the presence of one or more of the following findings: increase in sputum purulence, increase in sputum volume, and worsening of dyspnea. Patients with COPO present acute decompensation one to three times a year, and 3% to 10% require hospitalization.1.2 Assessment of the magnitude of these three symptoms can determine the severity of an exacerbation. When all three symptoms are present, it is a type I exacerbation. If any two of the three symptoms are present, it is 101 G. Ortiz-Ruiz et al. (eds.), Sepsis