title: [Multidimensional impact of COPD exacerbations].
abstract: One of the inherent characteristics of chronic obstructive pulmonary disease (COPD) is the occurrence of exacerbations. These episodes of clinical decompensation, which used to be considered epiphenomena of the disease, are now viewed as key elements in the natural history of COPD. Exacerbations generate huge clinical workload and enormous costs, impair patients' quality of life, make a decisive contribution to the multidimensional progression of the disease and affect prognosis. The present article reviews the current scientific evidence on the multifaceted impact of COPD exacerbations. However, the effects of exacerbations are not homogeneous. Not all patients suffer exacerbations and not all exacerbations have the same repercussions. This review highlights the need to standardize the definition of exacerbation, as well as that of concepts such as the frequency, severity, and duration of the episode. These factors influence the effect of the exacerbation itself and introduce variables that may affect treatment. Indeed, there is an increasing need to identify specific clinical phenotypes and personalize treatment. Consequently, an "exacerbating" phenotype is postulated as a therapeutic target of special importance.
authors.affiliation: Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia, España. jjsoler@telefonica.net
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Soler-Cataluña
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Martínez-García
authors.forename: Pablo Catalán
authors.initials: PC
authors.lastname: Serra
mesh_terms: D000208:Acute Disease; D015897:Comorbidity; D019468:Disease Management; D018450:Disease Progression; D006801:Humans; D007249:Inflammation; D008954:Models, Biological; D018384:Oxidative Stress; D010641:Phenotype; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D012008:Recurrence; D012307:Risk Factors; D009626:Terminology as Topic