Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 4

Exacerbation rate, health status and mortality in COPD – a review of potential interventions

Authors Seemungal T, Hurst JR, Wedzicha JA

Published 29 May 2009 Volume 2009:4 Pages 203—223


Review by Single-blind

Peer reviewer comments 3

Terence AR Seemungal1, John R Hurst2, Jadwiga A Wedzicha2

1Department of Clinical Medical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago; 2Academic Unit of Respiratory Medicine, Royal Free and University College Medical School, University College London, UK

Abstract: COPD is prevalent in Western society and its incidence is rising in the developing world. Acute exacerbations of COPD, about 50% of which are unreported, lead to deterioration in quality of life and contribute significantly to disease burden. Quality of life deteriorates with time; thus, most of the health burden occurs in more severe disease. COPD severity and frequent and more severe exacerbations are all related to an increased risk of mortality. Inhaled corticosteroids (ICS) have similar effects on quality of life but ICS/long-acting bronchodilator combinations and the long-acting antimuscarinic tiotropium all improve health status and exacerbation rates and are likely to have an effect on mortality but perhaps only with prolonged use. Erythromycin has been shown to decrease the rate of COPD exacerbations. Pulmonary rehabilitation and regular physical activity are indicated in all severities of COPD and improve quality of life. Noninvasive ventilation is associated with improved quality of life. Long-term oxygen therapy improves mortality but only in hypoxic COPD patients. The choice of an inhaler device is a key component of COPD therapy and this requires more attention from physicians than perhaps we are aware of. Disease management programs, characterized as they are by patient centeredness, improve quality of life and decrease hospitalization rates. Most outcomes in COPD can be modified by interventions and these are well tolerated and have acceptable safety profiles.

Keywords: COPD, exacerbation, health burden, mortality, inhaled steroids, long-acting bronchodilators, long-acting antimuscarinic agents, macrolide, disease management program, tolerability, safety, pulmonary rehabilitation, exercise

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF] 


Other articles by this author:


Seemungal TA, Lun JC, Davis G, Neblett C, Chinyepi N, Dookhan C, Drakes S, Mandeville E, Nana F, Setlhake S, King CP, Pinto Pereira L, Delisle J, Wilkinson TM, Wedzicha JA

International Journal of Chronic Obstructive Pulmonary Disease 2011, 6:385-386

Published Date: 4 July 2011

Plasma homocysteine is elevated in COPD patients and is related to COPD severity

Terence AR Seemungal, Johanna Cho Fook Lun, Gershwin Davis, Carlos Neblett, Nkhabe Chinyepi, et al

International Journal of Chronic Obstructive Pulmonary Disease 2007, 2:313-321

Published Date: 15 October 2007

Readers of this article also read:

Emerging and future therapies for hemophilia

Carr ME, Tortella BJ

Journal of Blood Medicine 2015, 6:245-255

Published Date: 3 September 2015

Acquired hemophilia A: emerging treatment options

Janbain M, Leissinger CA, Kruse-Jarres R

Journal of Blood Medicine 2015, 6:143-150

Published Date: 8 May 2015

A new recombinant factor VIII: from genetics to clinical use

Santagostino E

Drug Design, Development and Therapy 2014, 8:2507-2515

Published Date: 12 December 2014

Patient preference and ease of use for different coagulation factor VIII reconstitution device scenarios: a cross-sectional survey in five European countries

Cimino E, Linari S, Malerba M, Halimeh S, Biondo F, Westfeld M

Patient Preference and Adherence 2014, 8:1713-1720

Published Date: 12 December 2014

Second case report of successful electroconvulsive therapy for a patient with schizophrenia and severe hemophilia A

Saito N, Shioda K, Nisijima K, Kobayashi T, Kato S

Neuropsychiatric Disease and Treatment 2014, 10:865-867

Published Date: 16 May 2014

The use of PEGylated liposomes in the development of drug delivery applications for the treatment of hemophilia

Rivka Yatuv, Micah Robinson, Inbal Dayan-Tarshish, et al

International Journal of Nanomedicine 2010, 5:581-591

Published Date: 6 August 2010

Crystallization after intravitreal ganciclovir injection

Pitipol Choopong, Nattaporn Tesavibul, Nattawut Rodanant

Clinical Ophthalmology 2010, 4:709-711

Published Date: 14 July 2010