Exacerbation rate, health status and mortality in COPD--a review of potential interventions.
COPD is prevalent in Western society and its incidence is rising in the developing world. Acute exacerbations of COPD, about 50% of which are unreported, lead to deterioration in quality of life and contribute significantly to disease burden. Quality of life deteriorates with time; thus, most of the health burden occurs in more severe disease. COPD severity and frequent and more severe exacerbations are all related to an increased risk of mortality. Inhaled corticosteroids (ICS) have similar effects on quality of life but ICS/long-acting bronchodilator combinations and the long-acting antimuscarinic tiotropium all improve health status and exacerbation rates and are likely to have an effect on mortality but perhaps only with prolonged use. Erythromycin has been shown to decrease the rate of COPD exacerbations. Pulmonary rehabilitation and regular physical activity are indicated in all severities of COPD and improve quality of life. Noninvasive ventilation is associated with improved quality of life. Long-term oxygen therapy improves mortality but only in hypoxic COPD patients. The choice of an inhaler device is a key component of COPD therapy and this requires more attention from physicians than perhaps we are aware of. Disease management programs, characterized as they are by patient centeredness, improve quality of life and decrease hospitalization rates. Most outcomes in COPD can be modified by interventions and these are well tolerated and have acceptable safety profiles.
Seemungal
Terence A R
TA
Department of Clinical Medical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago. terence.seemungal@sta.uwi.edu
Hurst
John R
JR
Wedzicha
Jadwiga A
JA
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017281:Cost of Illness; D004185:Disability Evaluation; D004359:Drug Therapy, Combination; D015444:Exercise; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy / Q000191:economics; D057285:Precision Medicine; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D012121:Respiration, Artificial / Q000191:economics; D012129:Respiratory Function Tests; D019141:Respiratory System Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists; D019141:Respiratory System Agents