Chronic obstructive pulmonary disease exacerbations and their impact on the long-term natural history of the disease

Exacerbations can occur at each stage of chronic obstructive pulmonary disease (COPD), but their frequency and severity increase with disease progression. Today exacerbations are known to hove severe immediate and delayed consequences, They aggravate symptoms (dyspnea, cough, and sputum), airflow, and FEV1 decline and impair quality of life all durably, with prolonged recovery time. They increase the risk of death. Their economic consequences are substantial, accounting for 60% of direct cost associated with COPD 3 and 9 billion euros per year. Prevention of exacerbations is a major public health objective and is an integral part of the COPD program defined by French health authorities for the 2005-2010 period. It is essential to improve quality of life and prevent worsening of the long-term course of COPD.