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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
CLINICAL ADVANCE IN COPD
Halpin D. M. G.
Royal Devon and Exeter Hospital Exeter, UK
Exacerbations key are important events in the natural history of chronic obstructive pulmonary disease (COPD). They are common and occur with greater frequency as disease severity increases. They produce distressing symptoms and are often frightening events for patients. They affect patients’ health-related quality of life and wellbeing, lead to a significant the risk of death and hospitalisation and account for a large proportion of the costs of managing the disease. This article discusses the evidence on prevention and treatment of exacerbations.
Prevention of exacerbations is a vital part of COPD management. Inhaled corticosteroids, long-acting beta agonists and long-acting anticholinergics reduce exacerbation rates as does stopping smoking, pulmonary rehabilitation and influenza vaccination. Exacerbations should be managed with increased doses or frequency of bronchodilators, oral corticosteroids and antibiotics if there is evidence of infection. Most exacerbations can be treated in the community, but some require hospital admission. Investigations are not required for exacerbations managed in the community, but patients with exacerbations severe enough to require hospitalisation should have a chest radiograph and arterial blood gas tensions measured. Oxygen therapy is important to treat episodes of respiratory failure, but, if patients are acidotic, they may require noninvasive ventilation. Hospital at home and assisted discharge schemes are effective and can be used to facilitate home care. Undertaking pulmonary rehabilitation shortly after an admission for an exacerbation speeds functional recovery and may reduce readmission rates.