[Exacerbation of chronic obstructive pulmonary disease]

Abstract

Exacerbations of chronic obstructive pulmonary disease (COPD) are considered to be episodes of instability that favor disease progression, reduce quality of life, increase the risk of death and cause substantial healthcare resource use. These exacerbations are due to bacterial and viral infections and environmental stressors. However, other concomitant diseases such as heart disease, other lung diseases (e.g. pulmonary embolism, aspiration or pneumothorax) and other systemic processes can trigger or complicate these exacerbations. The two factors with the greatest influence on the physiopathology of exacerbations are dynamic overinflation and local and systemic inflammation. In most patients, drug treatment includes short-acting bronchodilators, systemic corticosteroids and antibiotics. Hypoxemic respiratory failure requires controlled oxygen therapy. In hypercapnic respiratory failure, non-invasive positive pressure ventilation may allow time to be gained until other treatments begin to take effect and can thus avoid endotracheal intubation. The use of non-invasive mechanical ventilation should never delay intubation, if indicated. Hospital discharge criteria are based on both clinical and gasometric stabilization and on the patient's ability to manage his or her disease at home. Hospitalization at home can be a treatment option in COPD exacerbations and is as effective as conventional hospitalization.