Clinical Definition of COPD Exacerbations and Classification of Their Severity

Abstract

A standardized definition of chronic obstructive pulmonary disease (COPD) exacerbation still represents an unmet need in respiratory medicine; definitions currently rely on clinical empiricism with little evidence-based scientific support. Exacerbations of COPD are certainly clear events in the mind of practicing physicians. However, when one tries to provide simple concepts such as their definition and classification of severity, one realizes how little we know. Current symptom- and event-based definitions of a COPD exacerbation, as well as the classifications of the severity of COPD exacerbations, all have their own limitations. Efforts to assess the efficacy of new therapies in the treatment and prevention of COPD exacerbations have been hampered by the lack of a widely agreed upon and consistently used definition. There is a need for greater investment in research on COPD exacerbations in order to promote a better understanding of COPD exacerbations.

Zalecenia Polskiego Towarzystwa Chorób Płuc Dotyczące Rozpoznawania i Leczenia Przewlekłej Obturacyjnej Choroby Płuc

“…Zaostrzenie POChP jest to ostry incydent charakteryzujący się nasileniem objawów ze strony układu oddechowego ponad zwykłą, codzienną zmienność, który zmusza do zmiany dotychczasowego leczenia [167,168].…”

Intensive care in chronic obstructive pulmonary disease : treatment with non-invasive ventilation and long-term outcome

“…Respiratory infections, bacterial or viral, are the most common causes of AECOPD (80 % of all cases). But environmental triggers such as air pollutants or change in air temperature can also initiate an exacerbation [14][15]17 . The type of infection responsible for the exacerbation is often unclear 15 .…”

“…But environmental triggers such as air pollutants or change in air temperature can also initiate an exacerbation [14][15]17 . The type of infection responsible for the exacerbation is often unclear 15 . Of respiratory infections, 40-50 % are believed to be caused by bacteria and about 30% by virus 14 .…”

“…This definition is very broad and leads to great inclusion heterogeneity in studies on AECOPD [14][15][16] . The definition has not been validated in clinical trials 15 . Other definitions are also used, and this influences the effect of treatment reported in available studies 16 .…”

Hospital at Home for Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Definitions currently rely on clinical empiricism with little evidence-based scientific support (Caramori et al, 2009). Most common international guidelines and working groups provide very similar definition of a COPD exacerbation: "an event in the natural course of the disease characterized by a change in the patient's baseline dyspnea, cough and/or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD" (ATS/ERS guidelines, Celli et al, 2004;GOLD, 2009;BTS guidelines, 2007;CTS guidelines, O'Donnel et al, 2008; SEPAR/ALAT joint guidelines, Peces-Barba et al, 2008;Rodriguez-Roisin, 2000).…”