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Minerva Pneumologica 2011 June;50(2):129-46

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: English

An update on exacerbation in COPD

Scherr A. 1, Blasi F. 2, Stolz D. 1

1 Clinic of Respiratory Medicine. University Hospital Basel, Basel, Switzerland 2 Respiratory Medicine Section, Department of Pulmonary-Thoracic and Cardiovascular Surgery, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy


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Current guideline recommendations on exacerbation management in chronic obstructive pulmonary disease (COPD) are based on clinical criteria which often have been analysed only by retrospective observational studies. Additional effort to better understand the heterogeneous nature of exacerbations is needed. Numerous viral infections are now known to be a common cause of exacerbation in COPD. Despite the association of virus infections with severe exacerbations in hospitalized patients, the exact role of respiratory viruses in inflammatory changes during exacerbation needs further investigation. Bacterial pathogens are a common cause of exacerbation, but strategies to provide clear distinction of acute infection from colonisation have to be developed. New serum biomarkers correlated better than clinical characteristics with outcome in exacerbation, but evaluation by longitudinal intervention trials must follow. Procalcitonin guided antibiotic use in COPD exacerbations has shown to reduce antibiotic overuse in several subgroups. Recent systematic reviews suggest a reduction of treatment failure by antibiotic drugs in hospitalized patients. Antibiotics taken for more than five days provide probably no additional benefit. Investigations to reduce cumulative steroid exposition aim to define treatment duration and application dose more exactly. Non-invasive positive pressure ventilation reduces mortality in very severe exacerbations, but might be currently underused. Patients selected by criteria of exacerbation severity, severity of underlying disease or presence of infection are more likely to benefit from interventions as compared to those who are less ill. Increasing knowledge about the heterogeneity of COPD exacerbations might lead to a more specific management resulting in better outcome.

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