title: Research opportunities in the management of acute exacerbations of chronic obstructive pulmonary disease.
abstract: Acute exacerbations of chronic obstructive pulmonary disease are a common problem in the emergency department. Despite considerable research involving the management of this disease over the past decade, much remains unclear from an emergency medicine perspective. Increased research would better guide the management of these complex patients from the perspectives of the patient, the caregiver, and society. The major areas of research can be divided into diagnosis, therapy, and education. The reliability and validity of different definitions of acute exacerbations of chronic obstructive pulmonary disease need to be assessed. The utility and performance characteristics of diagnostic testing need to be determined for this difficult patient population. Specific diagnostic tests include measures of dyspnea, spirometry and exercise tolerance, measures of gas exchange, airway inflammation, and chest imaging. It remains unclear which patient-specific therapies (oxygen, bronchodilators, corticosteroids, antibiotics, noninvasive positive pressure ventilation, and methylxanthines) should be used and monitored. Finally, the utility of education of both health care providers and patients and how it may be applied to the acute setting need to be addressed.
authors.affiliation: Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA. howard.smithline@bhs.org
authors.forename: Howard A
authors.initials: HA
authors.lastname: Smithline
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.forename: Michael S
authors.initials: MS
authors.lastname: Radeos
authors.forename: Rita K
authors.initials: RK
authors.lastname: Cydulka
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004414:Dyspareunia / Q000175:diagnosis / Q000209:etiology; D004635:Emergency Medicine / Q000193:education / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D013902:Radiography, Thoracic; D012106:Research / Q000639:trends*; D013147:Spirometry / Q000379:methods
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents