REVIEWS  ADVANCES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 

Minerva Pneumologica 2009 March;48(1):45-50

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Managing severe acute exacerbations in COPD, including mechanical ventilation

Ambrosino N. ^{1, 2}, Carpenè N. ¹, Gherardi M. ¹, Vagheggini G. ²

¹ Pulmonary Diseases and Respiratory Intensive Care Unit Cardio-Thoracic Department University Hospital of Pisa, Pisa, Italy 2 Weaning and Pulmonary Rehabilitation Unit Auxilium Vitae, Volterra, Italy

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important events in the natural course of disease leading to worsening in lung function and in health related quality of life and, when associated with acute respiratory failure (ARF), to severe short- and long-term prognosis. Several clinical trials have supported therapy with short-acting b-agonists, theophylline, and anticholinergic bronchodilators and there is a rationale for corticosteroid therapy. Many studies have shown that routine antibiotics shortened the severity and/or the duration of an AECOPD episode. Other modalities include mucolytics/chest physical therapy in patients with secretions. Supplemental oxygen may be helpful, but due to the risk of worsening hypercapnia, it should be targeted to provide the minimal amount to maintain acceptable oxygenation. Non invasive ventilation (NIV) is a technique to deliver mechanical ventilation avoiding the complications of endotracheal intubation (ETI). Strong evidence supports the use of NIV for ARF to prevent ETI in patients with AECOPD. Non invasive ventilation should be applied under close clinical and physiological monitoring for signs of treatment failure and ETI should be promptly available in the case. A trained team, careful patient selection and optimal choice of devices, can optimize outcome. In conclusion acute exacerbations of COPD are severe events in the natural history of the diseases and should be promptly and adequately treated. Beside conventional medical treatment, non invasive mechanical ventilation is now a useful tool to cover the gap between oxygen therapy and the need of invasive mechanical ventilation and its related.