COPD is a major cause of hospital admissions in the UK, accounting for over one million in-patient bed days each year1
What is an exacerbation?
An exacerbation is a sustained worsening of a patient’s symptoms from his or her usual stable state that is beyond normal day-to-day variations, and is acute in onset. Commonly reported symptoms are:
The change in these symptoms often necessitates a change in medication.
COPD exacerbations are a significant burden to patients and the health service, especially if the result is a hospital admission. They are distressing and disruptive for patients (family, carers, etc) and account for a significant proportion of the healthcare costs of COPD. Proactive management can reduce the incidence and severity of exacerbations, which in turn will have a positive impact on patients’ health status.
What causes an exacerbation?
A number of factors are known to cause exacerbations of COPD. Although it is possible to culture bacteria from the sputum of patients with stable COPD there is evidence that bacteria are also responsible for exacerbations. Viruses are also important aetiological agents, especially during winter months. Non-infectious agents are also responsible for some exacerbations (i.e. a patient who continues to smoke)
The following are known causes of exacerbations of COPD:
| Infections |
|
Rhinoviruses (common cold) |
|
Influenza |
|
Parainfluenza |
|
Coronavirus |
|
Adenovirus |
|
Respiratory Synctial Virus |
|
C. pneumoniae |
|
H. influenzae |
|
S. pneumonia |
|
Staph aureus |
|
P. aeruginosa |
| Common pollutants |
|
Nitrogen Dioxide |
|
Sulphur dioxide |
|
Ozone |
Impact of exacerbations on the patient:
Exacerbations may lead to an irreversible decline in lung function and disease progression
Frequent exacerbations are associated with:
These factors contribute to increased hospital admissions and increased length of stay for the patient.
Lung function declines up to 25%faster each year in patients with frequent exacerbations, and as FEV1 declines, exacerbations become increasingly more common and more severe.
It is highly unlikely that a patient will regain their ‘pre-exacerbation’ health status following an exacerbation.
Useful Links
Treating Patients with COPD: Community or Home Management...
Exacerbations in COPD A4 V1 - 