The Evidence Base for Management of Acute Exacerbations of COPD

Snow, Vincenza; Lascher, Steven; Mottur‐Pilson, Christel

doi:10.1378/chest.119.4.1185

Cited by 50 publications

(45 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These studies were reviewed in 2001 in an evidencebased process conducted jointly by the American College of Physicians and the American Society of Internal Medicine [29]. At that time, only 11 studies had been conducted to identify predictors of in-patient mortality, and eight had identified such factors in populations ranging 74-3,050 subjects, recruited with markedly variable inclusion criteria.…”

Section: Risk Factors For In-hospital Deathmentioning

confidence: 99%

Predictors of outcomes in COPD exacerbation cases presenting to the emergency department

Roche

Zureik²,

Soussan³

et al. 2008

European Respiratory Journal

131

105

View full text Add to dashboard Cite

The aim of the present prospective multicentric study was to develop a simple rule for the prediction of poor outcome in patients presenting to emergency departments with initially non-life threatening-chronic obstructive pulmonary disease (COPD) exacerbations in a real-life setting.All patients with an acute exacerbation of COPD visiting the emergency departments of 103 hospitals during a 3-month period were included, except those who immediately required intensive care unit admission and/or ventilatory support. The data collected included patient characteristics, in-hospital outcomes (mortality and length of stay) and mode of discharge (unsupported or need for post-hospital assistance).The in-hospital mortality rate was 7.4% (59 out of 794). Independent prognostic factors were age, number of clinical signs of severity (among cyanosis, impaired neurological status, lower limb oedema, asterixis and use of accessory inspiratory or expiratory muscles) and dyspnoea grade in the stable state. The need for post-hospital support was also predicted by female sex. In order to construct and validate a prediction score for mortality based on these items, patients were randomly allocated to a derivation and a validation cohort. The prediction score showed good discrimination, with a c-statistic of 0.79 in the derivation cohort and 0.83 in the validation cohort.Thus simple purely clinical factors can reliably predict the risk of death and requirement for post-hospital support in an initially non-life threatening-acute exacerbation of chronic obstructive pulmonary disease. Their use needs to be prospectively validated.

show abstract

Section: Risk Factors For In-hospital Deathmentioning

confidence: 99%

Predictors of outcomes in COPD exacerbation cases presenting to the emergency department

Roche

Zureik²,

Soussan³

et al. 2008

European Respiratory Journal

131

105

View full text Add to dashboard Cite

show abstract

“…The first management guidelines for acute exacerbations of chronic bronchitis that included stratification of patients according to severity were the Canadian guidelines [40]. The importance of risk factors for relapse was later explicitly recognised in the Latin American [41] and North American guidelines [42] for treatment of COPD exacerbations.…”

Section: Frequency and Outcomes Of Exacerbations: Risk Factors For Rementioning

confidence: 99%

Exacerbations of chronic obstructive pulmonary disease: when are bacteria important?

Miravitlles¹

2002

European Respiratory Journal

100

View full text Add to dashboard Cite

The progressive course of chronic obstructive pulmonary disease (COPD) is often aggravated by exacerbations, the majority of them produced by bronchial infection. Frequent exacerbations have been demonstrated to have a negative impact on quality of life and pulmonary function in patients with COPD, particularly in active smokers. Furthermore, acute exacerbations are the most frequent cause of medical visits, hospital admissions and death among patients with chronic lung disease.Evidence indicates that the number of patients with pathogenic bacteria in respiratory secretions and the bronchial bacterial load increase during exacerbations. Furthermore, the local inflammatory response of the host parallels the increase in bacterial load. From these observations, it can be speculated that, for symptoms of acute exacerbation to appear, there must be a minimum bacterial load in the airways, i.e. a threshold above which the inflammatory reaction is severe enough to elicit clinical symptoms of exacerbation. This threshold may vary from patient to patient owing to different modifying factors. Some of these factors may be the recognised risk factors for relapse, such as increasing age, impairment of lung function, comorbid conditions or frequent exacerbations in the past.Relapse rates after ambulatory treatment of acute exacerbation of COPD may be as high as 20-25% of cases. Relapses are associated with significant mordibity and increased costs.A number of unanswered questions remain regarding exacerbations of chronic obstructive pulmonary disease. These include the role of viral infection, the importance of residual bacterial colonisation and the impact of new antibiotics on the treatment of exacerbations. Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in developed countries. Furthermore, the number of individuals affected has grown since the 1980s [1]. In Spain, the prevalence of COPD is 9% in adults aged 40-70 yrs, although only 22% of these are diagnosed [2]. Tobacco smoking is the main aetiological factor for COPD. In a population-based study in Spain, 25% of the population aged 40-70 yrs were smokers and another 25% former smokers [3]. Only 15-20% of smokers will develop COPD, and smokers with COPD exhibit higher tobacco consumption and greater dependence on nicotine than smokers who do not have COPD, and more than one-third have never tried to stop smoking [3]. These figures indicate that the problem of COPD in most developed countries will continue to increase in the near future.The chronic and progressive course of COPD is often aggravated by short periods of increasing symptoms, particularly increasing cough, dyspnoea and production of sputum which can become purulent.

show abstract

“…The clinical distinction between these entities is not always clear, but, in the following, the focus is on patients who have acute exacerbations of COPD associated with chronic bronchitis or emphysema (AE-CB/COPD). There is no widely accepted definition of AE-CB/COPD, but most include one or more of three cardinal findings: worsening dyspnoea, increase in sputum purulence, and increase in sputum volume [83].…”

Section: Acute Exacerbation Of Chronic Bronchitis/chronic Obstructivementioning

confidence: 99%

“…The choice of antibiotics for empirical treatment is based on the spectrum of pathogens causing AE-CB/COPD, the local resistance situation and the severity of illness. It is important to point out that all placebo-controlled antibiotic studies have been performed with "older" drugs, such as amoxicillin, tetracyclines and trimethoprim/sulfamethoxazole, and that there are so far no published randomised blinded studies showing a superiority of newer drugs, such as cephalosporins or quinolones [83]. H. influenzae, or other Haemophilus species, and S. pneumoniae are the most common and important pathogens, followed by M. catarrhalis, and should be the primary target of treatment (table 3).…”

Section: Smentioning

confidence: 99%

Treatment of community-acquired lower respiratory tract infections in adults

Örtqvist¹

2002

European Respiratory Journal

View full text Add to dashboard Cite

The Evidence Base for Management of Acute Exacerbations of COPD

Cited by 50 publications

References 4 publications

Predictors of outcomes in COPD exacerbation cases presenting to the emergency department

Predictors of outcomes in COPD exacerbation cases presenting to the emergency department

Exacerbations of chronic obstructive pulmonary disease: when are bacteria important?

Treatment of community-acquired lower respiratory tract infections in adults

Contact Info

Product

Resources

About