The Chronic Obstructive Pulmonary Disease Exacerbation

Abstract

Chronic obstructive pulmonary disease is the only leading cause of death with a rising prevalence. The medical and economic costs arising from acute exacerbations of COPD are therefore expected to increase over the coming years. Although exacerbations may be initiated by multiple factors, the most common identifiable associations are with bacterial and viral infections. These are associated with approximately 50% to 70% and 20% to 30% of COPD exacerbations, respectively. In addition to smoking cessation, annual influenza vaccination is the most important method for preventing exacerbations. Controlled O2 is the most important intervention for patients with acute hypoxic respiratory failure. Evidence from randomized, controlled trials justifies the use of corticosteroids, bronchodilators (but not theophylline), noninvasive positive-pressure ventilation (in selected patients), and antibiotics, particularly for severe exacerbations. Antibiotics should be chosen according to the patient's risk for treatment failure and the potential for antibiotic resistance. In the acute setting, combined treatment with beta-agonist and anticholinergic bronchodilators is reasonable but not supported by randomized controlled studies. Physicians should identify and, when possible, correct malnutrition. Chest physiotherapy has no proven role in the management of acute exacerbations.

A National Survey on the Practice and Outcomes of Mechanical Ventilation in Korean Intensive Care Units

“…However, tuberculous lung disease was an important aetiology of acute-on-chronic respiratory failure patients requiring mechanical ventilation in Korea. Noninvasive positive pressure ventilation was not as frequently used in the Korean ICUs as in western countries 31 . our data suggest that the presence of full-time critical care physicians on site may facilitate adoption of recommended guidelines for MV use in Korea.…”

Cigarette Smoke Decreases Pulmonary Dendritic Cells and Impacts Antiviral Immune Responsiveness

“…The clinical course of COPD is often associated with acute exacerbations of symptoms (14)(15)(16)(17). Although exacerbations may be initiated by multiple factors, the most common identifiable associations are with bacterial and viral infections (18)(19)(20)(21)(22). This may suggest that cigarette smoke impacts respiratory defense mechanisms.…”

Tratamiento hospitalario de los episodios de agudización de la EPOC. Una revisión basada en la evidencia

“…En pacientes con EPOC grave (volumen espiratorio forzado en el primer segundo inferior al 35% del valor de referencia) las infecciones por bacilos gramnegativos, especialmente enterobacterias y Pseudomona, son frecuentes 28 . Basándose en estos datos epidemiológicos y espirométricos, en los pacientes en quienes se considere indicado el tratamiento antibió-tico, se recomienda el empleo de cefalosporinas, penicilinas de amplio espectro o quinolonas antipseudomóni-cas 2,8,12,28,29 . En todo caso, la elección del antibiótico debe basarse en la sensibilidad local de los citados gér-menes y en los antibióticos administrados al paciente antes del ingreso.…”