Toward a consensus definition for COPD exacerbations

ArticleinChest 117(5 Suppl 2):398S-401S · June 2000with18 Reads
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.


    • "The majority of the studies (53 out of 59) defined COPD diagnosis based on the Global initiative for chronic Obstructive Lung Disease (GOLD) criteria (FEV1/FVC <70%), and a bronchodilator effect of <12% in either the FEV1 or FVC [1]. 33 out of 59 studies defined an AECOPD based on worsening of symptoms including dyspnea, cough, or sputum production, which led to the intensification in the use of maintenance medications and/or institution of " rescue " medications [1,5]. Definitions of stable COPD were highly variable among the 59 studies, with duration free of exacerbation ranging from 3 weeks to 3 months (see S4 Table). "
    [Show abstract] [Hide abstract] ABSTRACT: The aims of this systematic review were to determine which blood-based molecules have been evaluated as possible biomarkers to diagnose chronic obstructive pulmonary disease (COPD) exacerbations (AECOPD) and to ascertain the quality of these biomarker publications. Patients of interest were those that have been diagnosed with COPD. MEDLINE, EMBASE, and CINAHL databases were searched systematically through February 2015 for publications relating to AECOPD diagnostic biomarkers. We used a modified guideline for the REporting of tumor MARKer Studies (mREMARK) to assess study quality. Additional components of quality included the reporting of findings in a replication cohort and the use of receiver-operating characteristics area-under-the curve statistics in evaluating performance. 59 studies were included, in which the most studied biomarkers were C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). CRP showed consistent elevations in AECOPD compared to control subjects, while IL-6 and TNF-α had variable statistical significance and results. mREMARK scores ranged from 6 to 18 (median score of 13). 12 articles reported ROC analyses and only one study employed a replication cohort to confirm biomarker performance. Studies of AECOPD diagnostic biomarkers remain inconsistent in their reporting, with few studies employing ROC analyses and even fewer demonstrating replication in independent cohorts.
    Full-text · Article · Jul 2016
    • "Acute exacerbation of chronic obstructive pulmonary disease (COPD) refers to a severe deterioration in the condition of a COPD patient that requires a medication change due to their baseline respiratory symptoms exceeding the daily fluctuation range [1, 2]. Patients with COPD frequently experience this acute exacerbation, which can reduce their quality of life and pulmonary function, while causing greater socioeconomic burden and accelerating disease progression [3, 4]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) causes not only an accelerated disease progression, but also an increased mortality rate. The purpose of this study was to analyze the factors associated with clinical features, comorbidities and mortality in patients at high risk for acute COPD exacerbation who had been hospitalized at least once in a year. Methods: The study enrolled 606 patients who had been diagnosed with and were being treated for COPD at university affiliated hospital. Among them, there were 61 patients at high risk for acute exacerbation of COPD who had been hospitalized at least once in a year. A retrospective analysis was conducted to examine the factors affecting mortality. The analysis divided the patients into non-survivor and survivor groups, and reviewed their medical records for clinical aspects, comorbidities, pulmonary function tests and blood tests. Results: In the high-risk group, the number of comorbidities at diagnosis (P = 0.020) and the Charlson comorbidity index value (P = 0.018) were higher in the non-survivor group than in the survivor group. During hospitalization, the non-survivor group had a significantly higher neutrophil (%) and a significantly lower lymphocyte (%) in complete blood count. Under stable conditions, the high-sensitivity C-reactive protein (hsCRP) concentration in blood plasma and neutrophil (%) were significantly higher (P = 0.025 and P = 0.036), while the lymphocyte (%) was significantly lower (P = 0.005) in the non-survivor group. A pulmonary function test revealed no statistically significant differences between the two groups. Conclusion: The number of comorbidities, neutrophil (%), lymphocyte (%) in complete blood cell (CBC) and hsCRP in blood plasma concentration among the groups at high risk for COPD exacerbation are associated with increased mortality.
    Full-text · Article · Jul 2016
    • "The patients were questioned for demographic features, comorbid diseases, medications used for COPD, smoking history, number of COPD exacerbations , and exacerbation-related hospitalizations during the previous year. An exacerbation of COPD is 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 [1,16,17]. Frequent exacerbation of COPD was defined as 2 exacerbations or 1 hospitalization for COPD exacerbation in the previous year [1]. To evaluate the severity of dyspnea and severity of symptoms associated with COPD, we used the modified Medical Research Council (mMRC) dyspnea scale (scoring 0e4) and COPD assessment test (CAT) (scoring 0e40) [18,19]. "
    [Show abstract] [Hide abstract] ABSTRACT: The relationship between chronic obstructive pulmonary disease (COPD) exacerbations and gastroesophageal reflux (GER) has been investigated less than asthma-GER. We aimed to evaluate the presence of GER in patients with COPD and its impact on exacerbations.
    Full-text · Article · Apr 2016
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