Chronic obstructive pulmonary disease (COPD) is the third leading cause
of death worldwide. While COPD is a mainly chronic disease, a
substantial number of patients suffer from exacerbations. Severe
exacerbations are related to a significantly worse survival outcome.
This review summarises the current knowledge on the different aspects of
COPD exacerbations. The impact of risk factors and triggers such as
smoking, severe airflow limitation, bronchiectasis, bacterial and viral
infections and comorbidities is discussed. More severe exacerbations
should be treated with β-agonists and anticholinergics as well as
systemic corticosteroids.
Antibiotic therapy should only be given to
patients with presumed bacterial infection. Noninvasive ventilation is
indicated in patients with respiratory failure. Smoking cessation is key
to prevent further COPD exacerbations. Other aspects include choice of
pharmacotherapy, including bronchodilators, inhaled corticosteroids,
phosphodiesterase-4 inhibitors, long-term antibiotics and mucolytics.
Better education and self-management as well as increased physical
activity are important. Influenza and pneumococcal vaccination is
recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of
COPD exacerbations, while most interventional bronchoscopic therapies
increase exacerbation risk within the first months after the procedure.
The prevention of exacerbations is one of the most important treatment
goals. To achieve that goal, patient education and smoking cessation
programmes as well as patient-tailored pharmacological and
nonpharmacological treatments are mandatory.
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