Targeting the COPD exacerbation

Exacerbations of COPD have a profound detrimental effect on the patient and impose a significant burden on healthcare resource utilization. Prevention and treatment of exacerbations are major objectives of the clinical management of COPD. For this approach to be successful, clinicians must combine both pharmacologic approaches and non-pharmacologic strategies aimed at improving the patient's disease management. Non-pharmacologic approaches include those that can be incorporated into the office setting as well as intervention strategies that are integrated into the lifelong management of COPD. These strategies include developing a partnership with the patient and their social supports, encouraging and facilitating smoking cessation, immunizations, proper use of supplemental oxygen, and most importantly, giving the patient the toots to manage their illness appropriately. Moreover there is clear evidence of an irrevocable decline in pulmonary function after each exacerbation, usually resulting in reduced physical activity and impaired skeletal muscle function. Not surprisingly, pulmonary rehabilitation after such events has been shown to prevent relapse, improve survival and enhance patients' overall function after acute exacerbations. It is now accepted that during an exacerbation there is an increased inflammation both in the lung and in the systemic circulation that can affect many organs and systems, causing serious complications. Several classes of pharmacological agents are currently available which have varying efficacy with regard to preventing exacerbations. However, further knowledge is needed regarding the varying clinical phenotypes of COPD and the mechanisms by which infections and other environmental agents trigger exacerbations, so that ultimately, pharmacologic therapy can be better targeted to provide specific patient benefits. (C) 2008 Elsevier Ltd. ALL rights reserved.