Impact and prevention of severe exacerbations of COPD: a review of the evidence

Abstract

Severe exacerbations of COPD, ie, those leading to hospitalization, have profound clinical implications for patients and significant economic consequences for society. The prevalence and burden of severe COPD exacerbations remain high, despite recognition of the importance of exacerbation prevention and the availability of new treatment options. Severe COPD exacerbations are associated with high mortality, have negative impact on quality of life, are linked to cardiovascular complications, and are a significant burden on the health-care system. This review identified risk factors that contribute to the development of severe exacerbations, treatment options (bronchodilators, antibiotics, corticosteroids [CSs], oxygen therapy, and ventilator support) to manage severe exacerbations, and strategies to prevent readmission to hospital. Risk factors that are amenable to change have been highlighted. A number of bronchodilators have demonstrated successful reduction in risk of severe exacerbations, including long-acting muscarinic antagonist or long-acting β2-agonist mono- or combination therapies, in addition to vaccination, mucolytic and antibiotic therapy, and nonpharmacological interventions, such as pulmonary rehabilitation. Recognition of the importance of severe exacerbations is an essential step in improving outcomes for patients with COPD. Evidence-based approaches to prevent and manage severe exacerbations should be implemented as part of targeted strategies for disease management.

Risk factors of chronic obstructive pulmonary disease exacerbations

“…Diabetes has a negative impact on the COPD evolution by shortening time to first sever EACOPD requiring hospitalisation, by increasing hospitalisation time and by increasing the risk of death during exacerbations. The sputum culture of COPD patients, in the presence of diabetes, is also associated with the isolation of more aggressive bacteria …”

“…However this condition is associated with an increased risk of death among COPD patients, because of more frequent exacerbations. Furthermore, OSAS leads to a higher risk of developing CVD such as pulmonary hypertension or right heart failure …”

“…The sputum culture of COPD patients, in the presence of diabetes, is also associated with the isolation of more aggressive bacteria. 103,111,[128][129][130][131]…”

“…Furthermore, OSAS leads to a higher risk of developing CVD such as pulmonary hypertension or right heart failure. 131,132 | 191 HOGEA Et Al.…”

In vivo experimental models of infection and disease

“…103 Acute exacerbations of COPD are the major drivers of morbidity, mortality, and healthcare costs in COPD and prevention of exacerbations a major unmet need. 104 Acute bacterial infection was believed to be the main cause of COPD exacerbations and this is reflected in the widespread use of antibiotics in COPD exacerbations. 105,106 Although COPD exacerbations are preceded by upper respiratory symptoms in up to two-thirds of cases, virus detection rates in the pre-PCR era were low.…”