Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2009

Open Access 01-12-2009 | Review

Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review

Authors: John R Hurst, Jadwiga A Wedzicha

Published in: BMC Medicine | Issue 1/2009

Login to get access

Abstract

Exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of this prevalent and devastating condition. This review provides a concise, state of the art summary on prevention and management of exacerbations. Considerable new data underpins evidence in support of many preventative interventions, pharmacological and non-pharmacological, that are now available. Challenges remain in developing new approaches, and delivering those that already exist to the right patient at the right time. Management of an exacerbation remains stepwise according to clinical severity, but there is now additional focus on addressing comorbidities and taking the opportunity at acute events to optimise preventative strategies for the future. Ultimately, exacerbations are heterogeneous events in a heterogeneous disease, and an individualised approach is paramount.
Appendix
Available only for authorised users
Literature
1.
Mannino DM, Buist AS: Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007, 370: 765-773. 10.1016/S0140-6736(07)61380-4.CrossRefPubMed
2.
3.
Hurst JR, Wedzicha JA: The biology of a chronic obstructive pulmonary disease exacerbation. Clin Chest Med. 2007, 28: 525-536. 10.1016/j.ccm.2007.05.003.CrossRefPubMed
4.
5.
Kanner RE, Anthonisen NR, Connett JE: Lower respiratory illnesses promote FEV1 decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001, 164: 358-364.CrossRefPubMed
6.
Donaldson GC, Seemungal TAR, Bhowmik A, Wedzicha JA: Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002, 57: 847-852. 10.1136/thorax.57.10.847.CrossRefPubMedPubMedCentral
7.
Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA: Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998, 157: 1418-1422.CrossRefPubMed
8.
Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, Salcedo E, Navarro M, Ochando R: Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005, 60: 925-931. 10.1136/thx.2005.040527.CrossRefPubMedPubMedCentral
9.
Anzueto A, Wedzicha JA, Hurst JR, Vestbo J, Yates J, Tal-Singer R, Miller D: Diagnosis of COPD exacerbations and their distribution based on GOLD severity stages. Am J Respir Crit Care Med. 2009, 179: A1527.
10.
Seemungal TA, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha JA: Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000, 161: 1608-1613.CrossRefPubMed
11.
Hurst JR, Wedzicha JA: What is (and what is not) an exacerbation of COPD: thoughts from the new GOLD guidelines. Thorax. 2007, 62: 198-199. 10.1136/thx.2007.077883.CrossRefPubMedPubMedCentral
12.
National Institute for Clinical Excellence (NICE): Chronic obstructive pulmonary disease: national clinical guideline for management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax. 2004, 59-Suppl 1
13.
Celli BR, MacNee W, ATS/ERS Task Force: Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004, 23: 932-946. 10.1183/09031936.04.00014304.CrossRefPubMed
14.
Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA: Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987, 106: 196-204.CrossRefPubMed
15.
Puhan MA, Vollenweider D, Steurer J, Bossuyt PM, Ter Riet G: Where is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review. BMC Med. 2008, 6: 28-10.1186/1741-7015-6-28.CrossRefPubMedPubMedCentral
16.
El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM: Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. 2008, 63: 415-422. 10.1136/thx.2007.090613.CrossRefPubMed
17.
Davies L, Angus RM, Calverley PM: Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Lancet. 1999, 354: 456-460. 10.1016/S0140-6736(98)11326-0.CrossRefPubMed
18.
Barnes PJ, Adcock IM: Glucocorticoid resistance in inflammatory diseases. Lancet. 2009, 373: 1905-1917. 10.1016/S0140-6736(09)60326-3.CrossRefPubMed
19.
McCrory DC, Brown CD: Anticholinergic bronchodilators versus beta2-sympathomimetic agents for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2003, 1: CD003900.
20.
Walters JA, Gibson PG, Wood-Baker R, Hannay M, Walters EH: Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2009, 1: CD001288.PubMed
21.
Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, Garcia-Aymerich J, Barnes NC: Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006, 2: CD004403.PubMed
22.
Barr RG, Rowe BH, Camargo CA: Methylxanthines for exacerbations of chronic obstructive pulmonary disease: meta-analysis of randomised trials. BMJ. 2003, 327: 643-10.1136/bmj.327.7416.643.CrossRefPubMedPubMedCentral
23.
Picot J, Lightowler J, Wedzicha JA: Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004, 3: CD004104.PubMed
24.
Nevins ML, Epstein SK: Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest. 2001, 119: 1840-1849. 10.1378/chest.119.6.1840.CrossRefPubMed
25.
Ram FS, Wedzicha JA, Wright J, Greenstone M: Hospital at home for patients with acute exacerbations of chronic obstructive pulmonary disease: systematic review of evidence. BMJ. 2004, 329: 315-10.1136/bmj.38159.650347.55.CrossRefPubMedPubMedCentral
26.
Eaton T, Young P, Fergusson W, Moodie L, Zeng I, O'Kane F, Good N, Rhodes L, Poole P, Kolbe J: Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study. Respirology. 2009, 14: 230-238. 10.1111/j.1440-1843.2008.01418.x.CrossRefPubMed
27.
Puhan MA, Scharplatz M, Troosters T, Steurer J: Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality – a systematic review. Respir Res. 2005, 6: 54-10.1186/1465-9921-6-54.CrossRefPubMedPubMedCentral
28.
Roede BM, Bresser P, Bindels PJ, Kok A, Prins M, ter Riet G, Geskus RB, Herings RM, Prins JM: Antibiotic treatment is associated with reduced risk of a subsequent exacerbation in obstructive lung disease: an historical population based cohort study. Thorax. 2008, 63: 968-973. 10.1136/thx.2008.095349.CrossRefPubMed
29.
Hurst JR, Donaldson GC, Quint JK, Goldring JJ, Baghai-Ravary R, Wedzicha JA: Temporal clustering of exacerbations in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009, 179: 369-374. 10.1164/rccm.200807-1067OC.CrossRefPubMed
30.
Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Müller C, Huber P, Müller B, Tamm M: Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest. 2007, 131: 9-19. 10.1378/chest.06-1500.CrossRefPubMed
31.
Sethi S, Murphy TF: Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008, 359: 2355-2365. 10.1056/NEJMra0800353.CrossRefPubMed
32.
Wilkinson TMA, Donaldson GC, Hurst JR, Seemungal TAR, Wedzicha JA: Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004, 169: 1298-1303. 10.1164/rccm.200310-1443OC.CrossRefPubMed
33.
Turnock AC, Walters EH, Walters JA, Wood-Baker R: Action plans for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2005, 4: CD005074.PubMed
34.
Effing T, Monninkhof EM, van der Valk PD, Zielhuis GA, Walters EH, van Herwaarden CL, van der Palen JJ, Zwerink M: Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev . 2007, 4: CD002990.PubMed
35.
Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, Yates JC, Vestbo J, TORCH investigators: Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007, 356: 775-789. 10.1056/NEJMoa063070.CrossRefPubMed
36.
Tashkin DP, Celli B, Senn S, Burkhart D, Kesten S, Menjoge S, Decramer M, UPLIFT Study Investigators: A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008, 359: 1543-1554. 10.1056/NEJMoa0805800.CrossRefPubMed
37.
Aaron SD, Vandemheen KL, Fergusson D, Maltais F, Bourbeau J, Goldstein R, Balter M, O'Donnell D, McIvor A, Sharma S, Bishop G, Anthony J, Cowie R, Field S, Hirsch A, Hernandez P, Rivington R, Road J, Hoffstein V, Hodder R, Marciniuk D, McCormack D, Fox G, Cox G, Prins HB, Ford G, Bleskie D, Doucette S, Mayers I, Chapman K, Zamel N, FitzGerald M, Canadian Thoracic Society/Canadian Respiratory Clinical Research Consortium: Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2007, 146: 545-555.CrossRefPubMed
38.
Puhan MA, Bachmann LM, Kleijnen J, Ter Riet G, Kessels AG: Inhaled drugs to reduce exacerbations in patients with chronic obstructive pulmonary disease: a network meta-analysis. BMC Med. 2009, 7: 2-10.1186/1741-7015-7-2.CrossRefPubMedPubMedCentral
39.
Wedzicha JA, Calverley PM, Seemungal TA, Hagan G, Ansari Z, Stockley RA, INSPIRE Investigators: The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med. 2008, 177: 19-26. 10.1164/rccm.200707-973OC.CrossRefPubMed
40.
41.
Zheng JP, Kang J, Huang SG, Chen P, Yao WZ, Yang L, Bai CX, Wang CZ, Wang C, Chen BY, Shi Y, Liu CT, Chen P, Li Q, Wang ZS, Huang YJ, Luo ZY, Chen FP, Yuan JZ, Yuan BT, Qian HP, Zhi RC, Zhong NS: Effect of carbocisteine on acute exacerbation of chronic obstructive pulmonary disease (PEACE Study): a randomised placebo-controlled study. Lancet. 2008, 371: 2013-2018. 10.1016/S0140-6736(08)60869-7.CrossRefPubMed
42.
Seemungal TA, Wilkinson TM, Hurst JR, Perera WR, Sapsford RJ, Wedzicha JA: Long-term erythromycin therapy is associated with decreased chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med. 2008, 178: 1139-1147. 10.1164/rccm.200801-145OC.CrossRefPubMed
43.
Black P, Staykova T, Chacko E, Ram FS, Poole P: Prophylactic antibiotic therapy for chronic bronchitis. Cochrane Database Syst Rev. 2003, 1: CD004105.PubMed
44.
Quint JK, Baghai-Ravary R, Donaldson GC, Wedzicha JA: Relationship between depression and exacerbations in COPD. Eur Respir J. 2008, 32: 53-60. 10.1183/09031936.00120107.CrossRefPubMed
45.
Poole PJ, Chacko E, Wood-Baker RW, Cates CJ: Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006, 1: CD002733.PubMed
46.
Casaburi R, ZuWallack R: Pulmonary rehabilitation for management of chronic obstructive pulmonary disease. N Engl J Med. 2009, 360: 1329-1335. 10.1056/NEJMct0804632.CrossRefPubMed
47.
Washko GR, Fan VS, Ramsey SD, Mohsenifar Z, Martinez F, Make BJ, Sciurba FC, Criner GJ, Minai O, Decamp MM, Reilly JJ, National Emphysema Treatment Trial Research Group: The effect of lung volume reduction surgery on chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med. 2008, 177: 164-169. 10.1164/rccm.200708-1194OC.CrossRefPubMed
48.
Nocturnal Oxygen Therapy Trial Group: Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med. 1980, 93: 391-398.CrossRef
49.
Medical Research Council Working Party: Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet. 1981, 1: 681-686.
50.
Garcia-Aymerich J, Monsó E, Marrades RM, Escarrabill J, Félez MA, Sunyer J, Antó JM, EFRAM Investigators: Risk factors for hospitalization for a chronic obstructive pulmonary disease exacerbation. EFRAM study. Am J Respir Crit Care Med. 2001, 164: 1002-1007.CrossRefPubMed
51.
McEvoy RD, Pierce RJ, Hillman D, Esterman A, Ellis EE, Catcheside PG, O'Donoghue FJ, Barnes DJ, Grunstein RR, Australian trial of non-invasive Ventilation in Chronic Airflow Limitation (AVCAL) Study Group: Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial. Thorax. 2009, 64: 561-566. 10.1136/thx.2008.108274.CrossRefPubMed
Metadata
Title
Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review
Authors
John R Hurst
Jadwiga A Wedzicha
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2009
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-7-40

Other articles of this Issue 1/2009

BMC Medicine 1/2009 Go to the issue

Research article

The risk of colorectal cancer with symptoms at different ages and between the sexes: a case-control study

Research article

Psychoeducation for depression, anxiety and psychological distress: a meta-analysis

Research article

Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study

Research article

Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature

Commentary

New perspectives in human stem cell therapeutic research

Commentary

Inclusion of women in clinical trials