Toward a consensus definition for COPD exacerbations

Department of Medicine, University of Barcelona, Barcelona, Spain.
Chest (Impact Factor: 7.48). 06/2000; 117(5 Suppl 2):398S-401S. DOI: 10.1378/chest.117.5_suppl_2.398S
Source: PubMed


In patients with COPD, an acute worsening of respiratory symptoms is often described as an exacerbation. Exacerbations are associated with a significant increase in mortality, hospitalization, and health-care utilization, but there is currently no widely accepted definition of what constitutes an exacerbation of COPD. This paper summarizes the discussions of the workshop, "COPD: Working Towards a Greater Understanding," in which the participants proposed the following working definition of an exacerbation of COPD: a sustained worsening of the patient's condition, from the stable state and beyond normal day-to-day variations, that is acute in onset and necessitates a change in regular medication in a patient with underlying COPD.

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    • "All patients were in stable clinical state and were free from exacerbations at least 4 weeks preceding recruitment. An exacerbation of COPD was defined as ''a sustained worsening of the patient's condition, from the stable state and beyond normal day-to-day variations, that is acute in onset and necessitates a change in regular medication'' [11]. Patients were excluded if they had the following: sleep apnea syndrome, other etiologies of chronic airway obstruction (e.g. "
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    ABSTRACT: The role of noninvasive positive pressure ventilation (NPPV) has been well established in the treatment of acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD), however, its benefits in clinically stable hypercapnic COPD patients still not well known, so this trial aimed to assess the efficacy of NPPV in patients with stable hypercapnic COPD.
    03/2015; 176(2). DOI:10.1016/j.ejcdt.2015.02.004
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    • "COPD is a leading cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing [1] [2]. An exacerbation of COPD is defined as an acute event characterized by a worsening of the patient's respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication [3] [4] [5]. "
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    ABSTRACT: Limited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease (eCOPD) attending an emergency department (ED). Such information could help to stratify these patients and guide medical decision-making. The aim of this study was to develop a clinical prediction rule for in-hospital mortality of eCOPD.
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    • ", further increases in its prevalence and mortality can be predicted in the coming decades [29]. AECOPD is defined as an event in the natural course of the disease characterized by a change in the patient's baseline dyspnea, cough, and/or sputum that is beyond normal dayto-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD [30] [31]. The aim of the study is to evaluate the impact of using nitroglycerin infusion on weaning off mechanically ventilated COPD patients. "
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    ABSTRACT: Mechanical ventilation (MV) weaning trial can be compared to a cardiac stress test where spontaneous ventilation is a form of an exercise and therefore hemodynamic compromise can occur during the weaning process in critically ill patients. The combined increase in arterial pressure and heart rate during unsuccessful weaning is quite suggestive of weaning failure of cardiac origin. Assessment and prediction of weaning failure from cardiac origin remain complicated in patients with chronic obstructive pulmonary disease (COPD). Recent data showed that COPD itself is a powerful independent risk factor for cardiovascular morbidity and mortality, suggesting that occult cardiac dysfunction could be frequent in patients with COPD. The immediate transition from positive pressure mechanical ventilation to spontaneous ventilation may generate significant cardiopulmonary alterations that are complex and mainly include the inspiratory fall in intrathoracic pressure, the increase in work of breathing, and the catecholamine discharge that occur during abrupt transfer from mechanical ventilation to spontaneous breathing. Therefore, it could be suggested that a treatment targeting the cardiovascular system decreasing the preload might help the heart to tolerate the critical period of weaning more effectively.
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