Targeting the COPD Exacerbation

• Published in: Respiratory medicine 2008-06, Vol.102, p.S3-S15
• Main Authors: Decramer, Marc, Nici, Linda, Nardini, Stefano, Reardon, Jane, Rochester, Carolyn L, Sanguinetti, Claudio M, Troosters, Thierry
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Biological and medical sciences; Bronchodilator Agents - therapeutic use; Cholinergic Antagonists - therapeutic use; Chronic obstructive pulmonary disease, asthma; COPD; Evidence-Based Medicine; Exacerbation; Humans; Medical sciences; Miscellaneous; Oxygen Inhalation Therapy - methods; Patient Acceptance of Health Care; Pharmacotherapy; Pneumology; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - therapy; Pulmonary/Respiratory; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Secondary Prevention; Self-management; Smoking Cessation; Systematic consequences and prevention strategies
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/S0954-6111(08)70003-9

Summary Exacerbations of COPD have a profound detrimental effect on the patient and impose a significant burden on healthcare resource utilization. Prevention and treatment of exacerbations are major objectives of the clinical management of COPD. For this approach to be successful, clinicians must combine both pharmacologic approaches and non-pharmacologic strategies aimed at improving the patient's disease management. Non-pharmacologic approaches include those that can be incorporated into the office setting as well as intervention strategies that are integrated into the lifelong management of COPD. These strategies include developing a partnership with the patient and their social supports, encouraging and facilitating smoking cessation, immunizations, proper use of supplemental oxygen, and most importantly, giving the patient the tools to manage their illness appropriately. Moreover there is clear evidence of an irrevocable decline in pulmonary function after each exacerbation, usually resulting in reduced physical activity and impaired skeletal muscle function. Not surprisingly, pulmonary rehabilitation after such events has been shown to prevent relapse, improve survival and enhance patients' overall function after acute exacerbations.