[Acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD)]

Domenico Lorenzo Urso

DOI: https://doi.org/10.7175/cmi.v11i2.1308


Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Acute exacerbations of COPD (AECOPD) are important events in the natural history of this condition because they negatively impact health status, rate of hospitalization, disease progression, and mortality.

Viral and/or bacterial infections are the main cause of exacerbations. The treatments include systemic corticosteroids, bronchodilators, anticholinergics and/or short- or long-acting β2-agonists, and antibiotics in case of bacterial infections. In some cases, oxygen-therapy is indicated.

This article focuses on several aspects of AECOPD, including epidemiology, diagnostic approach, i.e. investigations and management of AECOPD.


COPD; Exacerbations; Bronchitis; Bronchodilators

Full Text



  • Buist AS, McBurnei MA, Vollmer VM, et al. International variation in the prevalence of COPD (the BOLD study): a population-based prevalence study. Lancet 2007; 370: 741-50; https://doi.org/10.1016/S0140-6736(07)61377-4
  • Hagstad S, Ekerljung L, Lindberg A, et al. COPD among non smokers-Report from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Respiratory Medicine 2012; 106: 980-8; https://doi.org/10.1016/j.rmed.2012.03.010
  • Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. J Glob Health 2015; 5: 020415; https://doi.org/10.7189/jogh.05.020415
  • Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD, 2017. Disponibile all’indirizzo http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/ (ultimo accesso giugno 2017)
  • Pellegrino R, Brusasco V, Viegi G, et al. Definition of COPD based on evidence or opinion? Eur Resp J 2008; 31: 681-2; https://doi.org/10.1183/09031936.00154307
  • Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet 2007; 370: 786-96; https://doi.org/10.1016/S0140-6736(07)61382-8
  • Hoogendoorn M, Feenstra TL, Hoogenveen RT, et al. Association between lung function and exacerbation frequency in patients with COPD. COPD 2010; 5: 435-44; https://doi.org/10.2147/COPD.S13826
  • Cao Z, Ong KC, Eng P, et al. Frequent hospital readmissions for acute exacerbation of COPD and their associated factors. Respirology 2006; 11: 188-95; https://doi.org/10.1111/j.1440-1843.2006.00819.x
  • Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 2010; 363: 1128-38; https://doi.org/10.1056/NEJMoa0909883
  • Ansueto A, Sethi S, Martinez FJ. Exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2007; 4: 554-64
  • Donaldson GC, Seemungal TAR, Bhomik A, et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57: 847-52; https://doi.org/10.1136/thorax.57.10.847
  • Singanayagam A, Schembri S, Chalmers JD. Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease a systematic review and meta-analysis. Ann Am Thorac Soc 2013; 10: 81-9; https://doi.org/10.1513/AnnalsATS.201208-043OC
  • National Institute for Health and Care Excellence (NICE). Chronic Obstructive Pulmonary Disease 2010. Disponibile all’indirizzo https://www.nice.org.uk/guidance/qs10 (ultimo accesso giugno 2017)
  • O’Donnell DE, Aaron S, Bourbeau J, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease – 2007 update. Can Respir J 2007; 14(Suppl B): 5B-32B; https://doi.org/10.1155/2007/830570; https://doi.org/10.1155/2007/926421
  • Anthonisen NR, Manfreda J, Warren CPW, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Inter Med 1987; 106: 196-204; https://doi.org/10.7326/0003-4819-106-2-196
  • Bandi V, Jakubowycs M, Kynion C, et al. Infectious exacerbations of chronic obstructive pulmonary disease associated with respiratory viruses and non-typeable Haemophilus influenzae. FEMS Immunol Med Microbiol 2003; 37: 69-75; https://doi.org/10.1016/S0928-8244(03)00100-7
  • Wedzicha JA. Role of viruses in exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2004; 1: 115-20; https://doi.org/10.1513/pats.2306030
  • Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med 2008; 359: 2355-65; https://doi.org/10.1056/NEJMra0800353
  • Lode H, Allewelt M, Balk S, et al. A prediction model for bacterial etiology in acute exacerbations of COPD. Infection 2007; 35: 143-9; https://doi.org/10.1007/s15010-007-6078-z
  • Rodriguez-Roisin R. COPD exacerbations. Thorax 2006; 61; 535-44; https://doi.org/10.1136/thx.2005.041863
  • Rennard SI. Treatment of stable chronic obstructive pulmonary disease. Lancet 2004; 364: 791-802; https://doi.org/10.1016/S0140-6736(04)16941-9
  • Roy SR, Milgron H. Management of the acute exacerbation of asthma. J Asthma 2003; 40: 593-604; https://doi.org/10.1081/JAS-120018776
  • Aaron SD. The use of ipratropium bromide for the management of acute asthma exacerbation in adults and children: A systematic review. J Asthma 2001; 38: 521-30; https://doi.org/10.1081/JAS-100107116
  • Cates CJ, Crilly JA, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev 2006; (2): CD000052; https://doi.org/10.1002/14651858.cd000052.pub2
  • Bach PB, Brown C, Gelfland SE, et al. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Ann Intern 2001; 134: 600-20; https://doi.org/10.7326/0003-4819-134-7-200104030-00016
  • Wood-Baker RR, Gison PG, Hannay M, et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005;(1): CD001288
  • Leuppi JD, Schueltz P, Bingisser R, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 2013; 309: 2223-31; https://doi.org/10.1001/jama.2013.5023
  • Quon BS, Gan WQ, Sin DD. Contemporary management of acute exacerbations of COPD: a systematic review and metaanalysis. Chest 2008; 133: 756-66; http://doi.org/10.1378/chest.07-1207
  • Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006; (2): CD004403; https://doi.org/10.1002/14651858.cd004403.pub2
  • Dimopoulos G, Siempos II, Korbila IP, et al. Comparison of first-line antibiotics with second-line antibiotics for acute exacerbations of chronic bronchitis: a metanalysis of randomized controlled trials. Chest 2007; 132: 447-55; https://doi.org/10.1378/chest.07-0149
  • Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Int Med 1980; 91: 391-8
  • Medical Research Council. Long-term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema: report of the Medical Research Council Working Party. Lancet 1981; 1: 681-6
  • Yeow M, Santanilla JI. Non invasive positive pressure ventilation in the emergency department. Emerg Med Clin N Am 2008; 26: 835-47; https://doi.org/10.1016/j.emc.2008.04.005
  • Keenan SP, Sinuff T, Cook DJ, et al. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med 2003; 138: 861-70; https://doi.org/10.7326/0003-4819-138-11-200306030-00007
  • Ram FS, Picot J, Lightowler J, et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2004;(3):CD004104; https://doi.org/10.1002/14651858.cd004104.pub3
  • Conti G, Antonelli M, Navalesi P, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med 2002; 28: 1701-7; https://doi.org/10.1007/s00134-002-1478-0
  • Merlani PG, Pasquina P, Granier JM, et al. Factors associated with failure of noninvasive positive pressure ventilation in the emergency department. Acad Emerg Med 2005; 12: 1206-15; https://doi.org/10.1111/j.1553-2712.2005.tb01499.x


Abstract: 1675 views
HTML: 1511 views
PDF: 1472 views


  • There are currently no refbacks.