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2016 ; 11 Spec Iss
(Spec Iss
): 21-30
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Exacerbations of COPD
#MMPMID26937187
Pavord ID
; Jones PW
; Burgel PR
; Rabe KF
Int J Chron Obstruct Pulmon Dis
2016[]; 11 Spec Iss
(Spec Iss
): 21-30
PMID26937187
show ga
Exacerbations of chronic obstructive pulmonary disease (COPD) are defined as
sustained worsening of a patient's condition beyond normal day-to-day variations
that is acute in onset, and that may also require a change in medication and/or
hospitalization. Exacerbations have a significant and prolonged impact on health
status and outcomes, and negative effects on pulmonary function. A significant
proportion of exacerbations are unreported and therefore left untreated, leading
to a poorer prognosis than those treated. COPD exacerbations are heterogeneous,
and various phenotypes have been proposed which differ in biologic basis,
prognosis, and response to therapy. Identification of biomarkers could enable
phenotype-driven approaches for the management and prevention of exacerbations.
For example, several biomarkers of inflammation can help to identify
exacerbations most likely to respond to oral corticosteroids and antibiotics, and
patients with a frequent exacerbator phenotype, for whom preventative treatment
is appropriate. Reducing the frequency of exacerbations would have a beneficial
impact on patient outcomes and prognosis. Preventative strategies include
modification of risk factors, treatment of comorbid conditions, the use of
bronchodilator therapy with long-acting ?2-agonists or long-acting muscarinic
antagonists, and inhaled corticosteroids. A better understanding of the
mechanisms underlying COPD exacerbations will help to optimize use of the
currently available and new interventions for preventing and treating
exacerbations.