Acute exacerbation of chronic obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) comprises a heterogeneous group of conditions, characterized by chronic airflow limitation and parenchymal destruction of lung parenchyma, with clinical manifestations of dyspnea, cough, sputum production, and impaired exercise tolerance. The clinical course of COPD is one of gradual progressive impairment, which may eventually lead to respiratory failure. Periods of relative clinical stability are interrupted by recurrent exacerbations. However, the de?nition of exacerbation is still imprecise and generally based on varying combinations of symptoms such as an increase in cough or sputum production, worsening of dyspnea, or changes in sputum purulence (1). An acute exacerbation has also been described as a sustained worsening of the patient's condition, from the stable state and beyond normal day-to-day variations, that is acute in onset and necessitates a change in regular medication in a patient with underlying COPD (2). This imprecise definition of COPD, largely based on experienced symptomatology by the patient without measurable parameters in order to define severity or outcome hampers at present every systematic approach of this disease condition. Based on the complexity of the sensation of breathlessness, generally considered as a key symptom during exacerbations, it can hypothesized AECOPD. Furthermore, considering an AECOPD as a sustained worsening of the patient's condition from the stable state and beyond normal day-to-day variations, systemic effects can be considered as part of this baseline or stable condition.