Definition, Causes, Pathogenesis, and Consequences of Chronic Obstructive Pulmonary Disease Exacerbations

Overview

Journal Clin Chest Med

Specialty Pulmonary Medicine

Date 2020 Aug 18

PMID 32800196

Citations 105

Authors

Andrew I Ritchie

Jadwiga A Wedzicha

Affiliations

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Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are episodes of symptom worsening which have significant adverse consequences for patients. Exacerbations are highly heterogeneous events associated with increased airway and systemic inflammation and physiological changes. The frequency of exacerbations is associated with accelerated lung function decline, quality of life impairment and increased mortality. They are triggered predominantly by respiratory viruses and bacteria, which infect the lower airway and increase airway inflammation. A proportion of patients appear to be more susceptible to exacerbations, with poorer quality of life and more aggressive disease progression than those who have infrequent exacerbations. Exacerbations also contribute significantly to healthcare expenditure. Prevention and mitigation of exacerbations are therefore key goals of COPD management.

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References

Silverman E . Exacerbations in chronic obstructive pulmonary disease: do they contribute to disease progression?. Proc Am Thorac Soc. 2007; 4(8):586-90. PMC: 2647649. DOI: 10.1513/pats.200706-068TH. View

Wedzicha J, Seemungal T . COPD exacerbations: defining their cause and prevention. Lancet. 2007; 370(9589):786-96. PMC: 7134993. DOI: 10.1016/S0140-6736(07)61382-8. View

Singh M, Lee S, Porter P, Xu C, Ohno A, Atmar R . Human rhinovirus proteinase 2A induces TH1 and TH2 immunity in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol. 2010; 125(6):1369-1378.e2. PMC: 2881843. DOI: 10.1016/j.jaci.2010.02.035. View

Hurst J, Vestbo J, Anzueto A, Locantore N, Mullerova H, Tal-Singer R . Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010; 363(12):1128-38. DOI: 10.1056/NEJMoa0909883. View

Erb-Downward J, Thompson D, Han M, Freeman C, McCloskey L, Schmidt L . Analysis of the lung microbiome in the "healthy" smoker and in COPD. PLoS One. 2011; 6(2):e16384. PMC: 3043049. DOI: 10.1371/journal.pone.0016384. View

Bhowmik A, Seemungal T, Donaldson G, Wedzicha J . Effects of exacerbations and seasonality on exhaled nitric oxide in COPD. Eur Respir J. 2005; 26(6):1009-15. DOI: 10.1183/09031936.05.00047305. View

Falsey A, Formica M, Hennessey P, Criddle M, Sullender W, Walsh E . Detection of respiratory syncytial virus in adults with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006; 173(6):639-43. PMC: 2662947. DOI: 10.1164/rccm.200510-1681OC. View

Rohde G, Wiethege A, Borg I, Kauth M, Bauer T, Gillissen A . Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study. Thorax. 2003; 58(1):37-42. PMC: 1746460. DOI: 10.1136/thorax.58.1.37. View

Groenewegen K, Schols A, Wouters E . Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest. 2003; 124(2):459-67. DOI: 10.1378/chest.124.2.459. View

10.

Leung J, Sin D . Biomarkers in airway diseases. Can Respir J. 2013; 20(3):180-2. PMC: 3814266. DOI: 10.1155/2013/204529. View

11.

Beckham J, Cadena A, Lin J, Piedra P, Glezen W, Greenberg S . Respiratory viral infections in patients with chronic, obstructive pulmonary disease. J Infect. 2005; 50(4):322-30. PMC: 7132437. DOI: 10.1016/j.jinf.2004.07.011. View

12.

Kanner R, Anthonisen N, Connett J . Lower respiratory illnesses promote FEV(1) decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease: results from the lung health study. Am J Respir Crit Care Med. 2001; 164(3):358-64. DOI: 10.1164/ajrccm.164.3.2010017. View

13.

Pascoe S, Locantore N, Dransfield M, Barnes N, Pavord I . Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials. Lancet Respir Med. 2015; 3(6):435-42. DOI: 10.1016/S2213-2600(15)00106-X. View

14.

Hurst J, Wilkinson T, Perera W, Donaldson G, Wedzicha J . Relationships among bacteria, upper airway, lower airway, and systemic inflammation in COPD. Chest. 2005; 127(4):1219-26. DOI: 10.1378/chest.127.4.1219. View

15.

Mallia P, Message S, Contoli M, Gray K, Telcian A, Laza-Stanca V . Lymphocyte subsets in experimental rhinovirus infection in chronic obstructive pulmonary disease. Respir Med. 2013; 108(1):78-85. PMC: 3969590. DOI: 10.1016/j.rmed.2013.09.010. View

16.

Mallia P, Message S, Gielen V, Contoli M, Gray K, Kebadze T . Experimental rhinovirus infection as a human model of chronic obstructive pulmonary disease exacerbation. Am J Respir Crit Care Med. 2010; 183(6):734-42. PMC: 3081284. DOI: 10.1164/rccm.201006-0833OC. View

17.

Howard P . A long-term follow-up of respiratory symptoms and ventilatory function in a group of working men. Br J Ind Med. 1970; 27(4):326-33. PMC: 1069423. DOI: 10.1136/oem.27.4.326. View

18.

Dal Negro R, Micheletto C, Tognella S, Visconti M, Guerriero M, Sandri M . A two-stage logistic model based on the measurement of pro-inflammatory cytokines in bronchial secretions for assessing bacterial, viral, and non-infectious origin of COPD exacerbations. COPD. 2006; 2(1):7-16. DOI: 10.1081/copd-200050680. View

19.

Mackay A, Kostikas K, Murray L, Martinez F, Miravitlles M, Donaldson G . Patient-reported Outcomes for the Detection, Quantification, and Evaluation of Chronic Obstructive Pulmonary Disease Exacerbations. Am J Respir Crit Care Med. 2018; 198(6):730-738. DOI: 10.1164/rccm.201712-2482CI. View

20.

Millares L, Ferrari R, Gallego M, Garcia-Nunez M, Perez-Brocal V, Espasa M . Bronchial microbiome of severe COPD patients colonised by Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis. 2014; 33(7):1101-11. PMC: 4042013. DOI: 10.1007/s10096-013-2044-0. View