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

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.

Factors Influencing Adherence to Treatment in COPD Patients and Its Relationship with Disease Exacerbations

“…It also improves the exercise tolerance and general health condition of patients [13,14,18,25,[27][28][29]. Therefore, it seems obvious that failure to regularly treat COPD deteriorates the course of the disease and increases mortality rate, which has also been shown in the research [12,16,18,22,30].…”

“…Treatment of the disease is www.pneumonologia.viamedica.pl a considerable burden to healthcare systems, and treatment of exacerbations of the disease is the most expensive, particularly if the patient needs to be hospitalised [2,3,5,10,24]. Exacerbations that are experienced by the patient from 0.5 to 3.5 times per year [25] worsen the quality of life and ventilation parameters, and increase mortality [11,24,26]. One factor associated with poor prognosis is unsatisfactory cooperation between the patient and doctor.…”

Results of Physiotherapy Treatments in Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review

“…2,3 Recurrent acute exacerbation of COPD (AECOPD) contributes significantly to the burden of the disease and is a leading cause of hospital admissions worldwide: Of COPD patients, 35% have at least one admission a year, and as many as 40% of admitted patients have two or more readmissions a year. 4 Exacerbations imply a worsening of symptoms and a reduction in lung function that, in a small proportion of patients, may not be recovered.…”

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 .…”