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Building toolkits for COPD exacerbations: lessons from the past and present

Sapey, Elizabeth; Bafadhel, Mona; Bolton, Charlotte Emma; Wilkinson, Thomas; Hurst, John R.; Quint, Jennifer K.

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Authors

Elizabeth Sapey

Mona Bafadhel

Thomas Wilkinson

John R. Hurst

Jennifer K. Quint



Abstract

In the nineteenth century, it was recognised that acute attacks of chronic bronchitis were harmful. 140 years later, it is clearer than ever that exacerbations of chronic obstructive pulmonary disease (ECOPD) are important events. They are associated with significant mortality, morbidity, a reduced quality of life and an increasing reliance on social care. ECOPD are common and are increasing in prevalence. Exacerbations beget exacerbations, with up to a quarter of in-patient episodes ending with readmission to hospital within 30 days. The healthcare costs are immense. Yet despite this, the tools available to diagnose and treat ECOPD are essentially unchanged, with the last new intervention (non-invasive ventilation) introduced over 25 years ago.

An ECOPD is ‘an acute worsening of respiratory symptoms that results in additional therapy’. This symptom and healthcare utility-based definition does not describe pathology and is unable to differentiate from other causes of an acute deterioration in breathlessness with or without a cough and sputum. There is limited understanding of the host immune response during an acute event and no reliable and readily available means to identify aetiology or direct treatment at the point of care (POC). Corticosteroids, short acting bronchodilators with or without antibiotics have been the mainstay of treatment for over 30 years. This is in stark contrast to many other acute presentations of chronic illness, where specific biomarkers and mechanistic understanding has revolutionised care pathways. So why has progress been so slow in ECOPD? This review examines the history of diagnosing and treating ECOPD. It suggests that to move forward, there needs to be an acceptance that not all exacerbations are alike (just as not all COPD is alike) and that clinical presentation alone cannot identify aetiology or stratify treatment.

Citation

Sapey, E., Bafadhel, M., Bolton, C. E., Wilkinson, T., Hurst, J. R., & Quint, J. K. (2019). Building toolkits for COPD exacerbations: lessons from the past and present. Thorax, 74(9), 898-905. https://doi.org/10.1136/thoraxjnl-2018-213035

Journal Article Type Article
Acceptance Date May 5, 2019
Online Publication Date Jul 3, 2019
Publication Date Jul 3, 2019
Deposit Date Jul 4, 2019
Publicly Available Date Mar 28, 2024
Journal Thorax
Print ISSN 0040-6376
Electronic ISSN 1468-3296
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 74
Issue 9
Pages 898-905
DOI https://doi.org/10.1136/thoraxjnl-2018-213035
Keywords Pulmonary and Respiratory Medicine
Public URL https://nottingham-repository.worktribe.com/output/2268162
Publisher URL https://thorax.bmj.com/content/early/2019/07/03/thoraxjnl-2018-213035

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