Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

1992 ◽  
Vol 5 (4) ◽  
pp. 217-223
Author(s):  
Connie J. Rexing ◽  
Scott D. Troyer ◽  
Diane D. Shackelford ◽  
Wallace E. Geck
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
The United States ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Adrenergic Agents ◽  
Copd Exacerbations ◽  
Sputum Production ◽  
Acute Exacerbations

Chronic obstructive pulmonary disease (COPD) is an ever present problem in the United States. Characterized by features of both bronchitis and emphysema, the course is generally slow and progressive. However, acute exacerbations do occur, averaging one to four exacerbations per patient per year. These exacerbations, typically characterized by increasing dyspnea, cough, and sputum production, often require immediate treatment. As single agents, both anticholinergic and β-adrenergic agents have been proven effective in acute COPD exacerbations, yet their combination may provide little added therapeutic effect over either agent alone. In light of questionable effectiveness and the potential for toxicity, the role of methylxanthines in the management of COPD has been critically evaluated over the past several years. Certain patients may show improvement from the use of corticosteroids and/or antibiotics during an acute exacerbation; however, these patients are not always easily identifiable. Lastly, patients presenting with a PaO2 < 60 mm Hg will usually benefit from oxygen therapy. This article discusses some of the current views on the efficacy of these various treatments for acute COPD exacerbations.

scholarly journals Management of chronic obstructive pulmonary disease: A review focusing on exacerbations

2020 ◽  
Vol 77 (4) ◽  
pp. 259-268
Author(s):  
Suzanne G Bollmeier ◽  
Aaron P Hartmann
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Patient Education ◽  
Disease Management ◽  
Pulmonary Disease ◽  
The United States ◽  
Chronic Obstructive ◽  
Severe Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
The Impact

Abstract Purpose Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in the United States. Exacerbations— acute worsening of COPD symptoms—can be mild to severe in nature. Increased healthcare resource use is common among patients with frequent exacerbations, and exacerbations are a major cause of the high 30-day hospital readmission rates associated with COPD. Summary This review provides a concise overview of the literature regarding the impact of COPD exacerbations on both the patient and the healthcare system, the recommendations for pharmacologic management of COPD, and the strategies employed to improve patient care and reduce hospitalizations and readmissions. COPD exacerbations significantly impact patients’ health-related quality of life and disease progression; healthcare costs associated with severe exacerbation-related hospitalization range from $7,000 to $39,200. Timely and appropriate maintenance pharmacotherapy, particularly dual bronchodilators for maximizing bronchodilation, can significantly reduce exacerbations in patients with COPD. Additionally, multidisciplinary disease-management programs include pulmonary rehabilitation, follow-up appointments, aftercare, inhaler training, and patient education that can reduce hospitalizations and readmissions for patients with COPD. Conclusion Maximizing bronchodilation by the appropriate use of maintenance therapy, together with multidisciplinary disease-management and patient education programs, offers opportunities to reduce exacerbations, hospitalizations, and readmissions for patients with COPD.

scholarly journals Inhalation glucocorticosteroids in the treatment of chronic obstructive pulmonary disease

2020 ◽  
Vol 30 (3) ◽  
pp. 330-343
Author(s):  
S. N. Avdeev ◽  
Z. R. Aisanov ◽  
V. V. Arkhipov ◽  
A. S. Belevskiy ◽  
I. V. Leshchenko ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive Lung Disease ◽  
Clinical Excellence ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Patient Reported ◽  
The Impact

The main objectives of chronic obstructive pulmonary disease (COPD) therapy are to reduce the severity of symptoms and the risk of exacerbations. The article discusses the role of local and systemic inflammation in the pathogenesis of COPD as well as various mechanisms of pharmacological influence on it. Approaches to prescribing basic therapy for patients with COPD, recommended by various national and global guidelines (clinical recommendations of the Russian respiratory society, criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), guidelines of the National Institute for Health and Clinical Excellence (NICE)), as well as recommendations on the therapy frequency review are considered. Currently, so-called triple combinations – fixed combinations of double bronchodilators with inhaled glucocorticosteroids – are being developed and registered in the world, and their place and significance in the treatment of COPD raise many discussions. The paper discusses the role of fixed triple combinations in reducing the incidence of COPD exacerbations, the impact on functional and patient-reported outcomes, and provides recommendations for the use of triple combinations in patients with COPD, taking into account the benefit/risk ratio.

Management of Chronic Obstructive Pulmonary Disease: A Review

2001 ◽  
Vol 14 (2) ◽  
pp. 126-142 ◽  
Author(s):  
Marie-France Beauchesne
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
The United States ◽  
Treatment Modalities ◽  
Chronic Obstructive ◽  
Duration Of Action ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbations

Chronic obstructive pulmonary disease (COPD) affects about 14 million persons in the United States and is the only common cause of death that is increasing in incidence. Chronic management of this disorder includes nonpharmacologic interventions such as smoking cessation, immunization, nutritional support, and pulmonary rehabilitation. The pharmacotherapy of COPD is based on regular administration of bronchodilators, when symptoms are persistent. Long-acting bronchodilators have been shown to improve quality of life in patients with COPD. Ipratropium remains the anticholinergic of choice, but more specific agents with a longer duration of action should become available. Four recent large clinical trials on the use of inhaled corticosteroids (ICS) have been published. The results demonstrate that ICS do not alter the decline in lung function in patients with COPD. Patients with more severe COPD and frequent exacerbations may have a better quality of life and a reduced rate of exacerbations with ICS. Management of acute exacerbations involves three major pharmacologic treatment modalities: antibiotics, short-acting bronchodilators, and systemic steroids. Recent data shows the benefits of systemic corticosteroids in the management of acute exacerbations.

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