Prevention of exacerbations

A decrease in the number of exacerbations experienced by patients is still a major unmet need in COPD.

Many COPD patients experience periodic worsening of their symptoms reflecting an acute deterioration in lung mechanics1 and airway inflammation secondary to viral and/or bacterial infection.2,3 These exacerbations contribute to impaired health status4,5 and increased hospitalization costs,6 and predict mortality.7

Exacerbations range from unreported increases in patients’ symptoms8 through to periods requiring ventilatory support.

The GOLD strategy document recommends that effective management of stable COPD should include the following goals9:

Reducing symptoms

• Relieve symptoms
• Improve exercise tolerance
• Improve health status

Reducing risk

• Prevent disease progression
• Prevent and treat exacerbations
• Reduce mortality

Preventing exacerbations in patients with COPD is important because it reduces future risk of hospitalization and mortality.9


  1. Stevenson NJ, Walker PP, Costello RW, et al. Lung mechanics and dyspnea during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006;172:1510-6.
  2. Papi A, Bellettato CM, Braccioni F, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med 2006;173:1114-21.  
  3. Sethi S, Maloney J, Grove L, et al. Airway inflammation and bronchial bacterial colonization in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006;173:991-8.
  4. Seemungal TA, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:1418-22.
  5. Spencer S, Calverley PM, Burge PS, et al. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J 2004;23:698-702.
  6. Andersson F, Borg S, Jannson SA, et al. The costs of exacerbations in chronic obstructive pulmonary disease. Respir Med 2002;96:700-8.
  7. Soler-Cataluna JJ, Martinez-Garcia MA, Roman Sanchez P, et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005;60:925-31.
  8. Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;161:1608-13.
  9. Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2013.

Inflammation in COPD

Learn more about the central role of inflammation in COPD.Go

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