What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement

Abstract

Chronic obstructive pulmonary disease (COPD) is a chronic illness that can be periodically punctuated by exacerbations, characterised by acute worsening of symptoms, including increased dyspnoea, cough, sputum production and sputum purulence. COPD exacerbations are common and have important clinical and economic consequences, including lost work productivity, increased utilisation of healthcare resources, temporary or permanent reductions in lung function and exercise capacity, hospitalisation, and sometimes death. Over the past two decades, clinicians and researchers have broadened their treatment goals for COPD to extend beyond improving lung function and symptoms, and have begun to address the importance of preventing and reducing exacerbations. However, despite the best efforts of clinicians and guideline committees, current definitions of COPD exacerbations are imperfect and fraught with problems. The cardinal symptoms of a COPD exacerbation are nonspecific and can result from acute cardiorespiratory illnesses other than COPD. A proposed definition, which may be more specific than current definitions, suggests that COPD exacerbation be defined as an acute or subacute worsening of dyspnoea (≥5 on a visual analogue scale that ranges from 0 to 10) sometimes but not necessarily accompanied by increased cough, sputum volume and/or sputum purulence. Necessary laboratory criteria for an exacerbation include oxygen desaturation ≤4% below that of stable state, elevated levels of circulating blood neutrophils or eosinophils (≥9000 neutrophils·mm−3 or ≥2% blood eosinophils) and elevated C-reactive protein (≥3 mg·L−1), without evidence of pneumonia or pulmonary oedema on chest radiography and with negative laboratory test results for other aetiologies. Herein, we discuss the current state of the art with respect to how we define COPD exacerbations, associated pitfalls and challenges, and opportunities for improvement.

Targeting Vitamin D Deficiency to Limit Exacerbations in Respiratory Diseases: Utopia or Strategy With Potential?

“…Studies have indicated that the quality of life and health status of patients are mainly determined by the presence and frequency of exacerbations [4]. Indeed, COPD exacerbations have important clinical and economic consequences, including lost work productivity, increased utilization of healthcare resources, temporary or permanent reductions in lung function and exercise capacity, hospitalization, and sometimes death [69]. Although the precise mechanisms of the onset of COPD exacerbations have not been fully clarified, the viral/bacterial infection-mediated immune response is thought to play a critical role.…”

Different source of sample strains corresponds to different characteristics of patients with non-tuberculous mycobacterium

“…As suggested by our study, BALF positive samples were closely associated with patients with bronchiectasis and sputum positive samples were associated with patients with COPD. In clinical practice, when bronchiectasis is suspected, a bronchoscopy test is suggested, while patients with COPD are not subjected to bronchoscopy especially when they suffer from exacerbation [15].…”

<p>Breathing–Swallowing Discoordination and Inefficiency of an Airway Protective Mechanism Puts Patients at Risk of COPD Exacerbation</p>

“…An exacerbation was classified as moderate or severe if at least one of the following were required: systemic steroid administration, antibiotic therapy, or hospital admission. 11 , 12 Upon inclusion, patients underwent the following dysphagia screening tests: the 10-item Eating Assessment Tool (EAT-10), 13 Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG), 14 repetitive saliva swallowing test (RSST), 15 water swallowing test (WST), 16 and simple swallow provocation test (SSPT). 17…”