Characterisation and prevention of exacerbations in frequently exacerbating patienst with COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is a disease which is characterised by airway inflammation and progressive airflow limitation with poor reversibility. Periods of acute deterioration lie in the natural course of the disease and are called exacerbations. In literature, there are different definitions for an acute exacerbation of COPD (AECOPD). A symptom reported AECOPD is defined solely based on a patient’s symptoms.1 This is regardless of whether the patient seeks medical attention or receives treatment for the exacerbation. An event defined AECOPD requires a therapeutic intervention such as a change in COPD medications or a change in healthcare utilization. Generally accepted is the definition as in the guidelines of the World Health Organization, US National Heart Lung and Blood Institute and Global Initiative for Chronic Obstructive Lung Disease (GOLD), which define an exacerbation as “an event in the natural course of the disease characterised by a change in the patient’s baseline dyspnoea, cough, and/ or sputum that is beyond normal day-to-day variations, is acute in onset and may warrant a change in regular medication in a patient with COPD”. Frequent exacerbations result in a decreased health related quality of life, a decline in lung function, an increased risk of hospitalization, and an increase in mortality. COPD and acute exacerbations of COPD impose a burden on health care and society. It is estimated that COPD is the 4th leading cause of death worldwide and will be the 3rd leading cause of death in 2030. Along with increasing mortality rates the loss in disability-adjusted life years (DALYs) will also rise. By 2030 COPD is predicted to be the 5th leading cause of loss in DALYs globally, where it was only number 13 in 2004. Increasing health care costs will be the consequence of this trend. In the European Union COPD accounts for just over 3% of the total health care budget. In the USA, the direct and indirect costs for COPD are almost 50 billion USD. The majority of these costs are attributed to exacerbations. The importance of exacerbations is reflected in the latest update of the GOLD report, in which the number of exacerbations in the preceding year is incorporated in the new classification of a patient with COPD. In order to try reduce mortality rates, loss in DALYs, and related costs to lower the burden on society and health care, it is a goal to prevent and treat COPD and exacerbations of COPD. This chapter will give a concise overview of the background of AECOPD and the available tools for its treatment and prevention.