Bringing Stability to the Chronic Obstructive Pulmonary Disease Patient: Clinical and Pharmacological Considerations for Frequent Exacerbators

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are critical events associated with accelerated loss of lung function, increased morbidity, and excess mortality. AECOPD are heterogeneous in nature and this may directly impact clinical decision making, specifically in patients with frequent exacerbations. A “frequent exacerbator” is a sub-phenotype of COPD that is defined as an individual who experiences ≥2 moderate to severe exacerbations per year. This distinct subgroup has higher mortality and account for more than half of COPD-related hospitalizations annually. Thus, it is imperative to identify individuals at risk for frequent exacerbations and choose optimal strategies to minimize risk for these events. New paradigms for utilizing combination inhalers and the introduction of novel oral compounds provide expanded treatment options to reduce the risk and frequency of exacerbations. The goals of managing frequent exacerbators or patients at risk for AECOPD are: 1) maximizing bronchodilation, 2) reducing inflammation, and 3) targeting specific molecular pathways implicated in COPD and AECOPD pathogenesis. Novel inhaler therapies include combination long acting muscarinic agents (LAMA) plus long acting beta agonists (LABA) show promising results compared to monotherapy or LABA inhaled corticosteroid (ICS) combination in reducing exacerbation risk among individuals at risk for exacerbations and among frequent exacerbators. Likewise, oral medications including macrolides and phosphodiesterase (PDE4) inhibitors reduce the risk for AECOPD in select groups of individuals at high risk for exacerbation. Future direction in COPD management is based on identification of various subtypes or “endotypes” and targeting therapies based on their pathophysiology. This review aims to describe the impact of AECOPD, challenges posed by frequent exacerbators, and explores the rationale for different pharmacologic approaches to preventing AECOPD in these individuals.

Jianpi Huatan Tongfu granule alleviates inflammation and improves intestinal flora in patients with acute exacerbation of chronic obstructive pulmonary disease

“…However, patients are likely to experience relapse after relief of symptoms; drug resistance, side effects, and other complications have been reported during hospitalization. 20 Jianpi Huatan Tongfu granule is a clinical prescription for the treatment of AECOPD. It has been used in TCM for many years, especially in the context of combined clinical treatment using Chinese and Western medicines, where it effectively alleviates the side effects of Western medicines.…”

Management of acute COPD exacerbations in France: A qualitative survey in a private practice setting

“…The goals of care for COPD management include reducing symptoms, improving health status and exercise tolerance, and reducing the risk of COPD exacerbations (periods of acute worsening of symptoms) to ultimately prevent disease progression and reduce mortality [ 1 ]. Acute exacerbations negatively impact health status, accelerate lung function decline, and increase mortality risk [ 1 , 5 ]. Overall, they account for more than half the hospitalizations in COPD [ 5 ].…”

“…Acute exacerbations negatively impact health status, accelerate lung function decline, and increase mortality risk [ 1 , 5 ]. Overall, they account for more than half the hospitalizations in COPD [ 5 ]. In France, a retrospective study of administrative records between 2007 and 2012 revealed that of 29,779 patients admitted to hospital with a severe exacerbation, over 8% died during hospitalization [ 6 ].…”

The Role of Human Leukocyte Antigen-DR in Regulatory T Cells in Patients with Virus-Induced Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Currently, both the pathology and treatment strategies of AECOPD are diverse [ 6 , 7 ]. The prevalence of viral infection in AECOPD was reported to be 42.7% in a recent trial [ 8 ].…”