Elizabeth Sapey
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.
Authors
Mona Bafadhel
Professor CHARLOTTE BOLTON charlotte.bolton@nottingham.ac.uk
Professor of Respiratory Medicine
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 | Aug 21, 2019 |
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 |
Contract Date | Jul 4, 2019 |
Files
Building Toolkits
(1.2 Mb)
PDF
Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/
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