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Exacerbations of COPD

Authors Pavord I, Jones P, Burgel PR, Rabe K, Finch D

Received 10 April 2015

Accepted for publication 13 October 2015

Published 19 February 2016 Volume 2016:11(1st World Lung Disease Summit) Pages 21—30


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Dr Richard Russell

Ian D Pavord,1 Paul W Jones,2 Pierre-Régis Burgel,3 Klaus F Rabe4,5

1Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK; 2Division of Clinical Science, St George’s, University of London, London, UK; 3Department of Respiratory Medicine, Cochin Hospital, University Paris Descartes, Sorbonne Paris Cité, Paris, France; 4Department of Medicine, Christian Albrecht University, Kiel, Germany; 5LungenClinic, Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany

Abstract: Exacerbations of chronic obstructive pulmonary disease (COPD) are defined as sustained worsening of a patient’s condition beyond normal day-to-day variations that is acute in onset, and that may also require a change in medication and/or hospitalization. Exacerbations have a significant and prolonged impact on health status and outcomes, and negative effects on pulmonary function. A significant proportion of exacerbations are unreported and therefore left untreated, leading to a poorer prognosis than those treated. COPD exacerbations are heterogeneous, and various phenotypes have been proposed which differ in biologic basis, prognosis, and response to therapy. Identification of biomarkers could enable phenotype-driven approaches for the management and prevention of exacerbations. For example, several biomarkers of inflammation can help to identify exacerbations most likely to respond to oral corticosteroids and antibiotics, and patients with a frequent exacerbator phenotype, for whom preventative treatment is appropriate. Reducing the frequency of exacerbations would have a beneficial impact on patient outcomes and prognosis. Preventative strategies include modification of risk factors, treatment of comorbid conditions, the use of bronchodilator therapy with long-acting β2-agonists or long-acting muscarinic antagonists, and inhaled corticosteroids. A better understanding of the mechanisms underlying COPD exacerbations will help to optimize use of the currently available and new interventions for preventing and treating exacerbations.

Keywords: COPD, exacerbation, phenotype, biomarker, bronchodilator

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