COPD exacerbations: definitions and classifications

Abstract

Chronic obstructive pulmonary disease (COPD) is defined independently of exacerbations, which are largely a feature of moderate-to-severe disease. This article is the result of a workshop that tried to define exacerbations of COPD for use in clinical, pharmacological and epidemiological studies. The conclusions represent the consensus of those present.This review describes definitions, ascertainment, severity assessments, duration and frequency, using varying sources of data including direct patient interview, healthcare databases and symptom diaries kept by patients in studies.The best general definition of a COPD exacerbation is the following: an exacerbation of COPD is a sustained worsening of the patient9s condition, from the stable state and beyond normal day-to-day variations that is acute in onset and may warrant additional treatment in a patient with underlying COPD.A more specific definition for studies where a bacteriological cause of exacerbation is being studied is included, as well as simpler definitions for retrospective identification from database sources. Prospective diary card assessments are best recorded as changes from an agreed baseline, rather than absolute symptom severities. Diary cards identify many unreported exacerbations, which on average have similar severities to reported exacerbations. A scale for exacerbation severity is proposed that incorporates in-and outpatient assessments. Exacerbation duration, which also relates to severity, is defined from diary card reports. Healthcare utilisation is not an adequate substitute for severity, depending on many unrelated social and comorbidity factors. It is an outcome in its own right.

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

“…105 An exacerbation of COPD is an acute event characterized by a worsening of respiratory symptoms beyond normal day-to-day variation, typically requiring changes in medication and possibly hospitalization. [106][107][108] Variable decrease in pulmonary function and the occurrence of tachypnea (excessively rapid breathing) are typical in acute exacerbations. 103 COPD exacerbations are especially important because they adversely affect quality of life, take weeks to resolve, accelerate decline in lung function, and potentially lead to death.…”

Upper Respiratory Symptoms Worsen over Time and Relate to Clinical Phenotype in Chronic Obstructive Pulmonary Disease

“…Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality 1 .The natural history of COPD is characterized by the repeated occurrence of episodes called exacerbations that are manifested by an inflammatory response, mediated predominantly by neutrophils that increase respiratory symptoms 2,3 .…”

Etiología y biomarcadores de inflamación sistémica en las exacerbaciones leves a moderadas de la enfermedad pulmonar obstructiva crónica

“…Las exacerbaciones fueron definidas según criterios clínicos 27 y el uso de recursos sanitarios, de acuerdo a la definición de Burge y Wedzicha 28 . Desde un punto de vista operacional, se consideró exacerbación leve a aquella tratada en el ámbito ambulatorio que requirió aumentar la terapia broncodilatadora con o sin uso de antibióticos, y exacerbación moderada a aquella que requirió tratamiento con antibióticos y corticoides sistémicos.…”