COPD exacerbations: causes, prevention, and treatment.
The mechanisms of COPD exacerbation are complex. Respiratory viruses (in particular rhinovirus) and bacteria play a major role in the causative etiology of COPD exacerbations. In some patients, noninfective environmental factors may also be important. Data recently published from a large observational study identified a phenotype of patients more susceptible to frequent exacerbations. Many current therapeutic strategies can reduce exacerbation frequency. Future studies may target the frequent exacerbator phenotype, or those patients colonized with potential bacterial pathogens, for such therapies as long-term antibiotics, thus preventing exacerbations by decreasing bacterial load or preventing new strain acquisition in the stable state. Respiratory viral infections are also an important therapeutic target for COPD. Further work is required to develop new anti-inflammatory agents for exacerbation prevention, and novel acute treatments to improve outcomes at exacerbation.
Academic Unit of Respiratory Medicine, Royal Free Campus, UCL Medical School, London, UK. alexander.mackay@ucl.ac.uk
Alex J
AJ
Mackay
John R
JR
Hurst
D000397:Air Pollution / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D018450:Disease Progression; D006801:Humans; D007251:Influenza, Human / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D008168:Lung / Q000601:surgery; D010641:Phenotype; D010850:Picornaviridae Infections / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D019141:Respiratory System Agents / Q000627:therapeutic use; D012138:Respiratory Therapy; D012229:Rhinovirus; D014611:Vaccination
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D019141:Respiratory System Agents