Management of chronic obstructive pulmonary disease: A review focusing on exacerbations

Abstract

Purpose: Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in the United States. Exacerbations- acute worsening of COPD symptoms-can be mild to severe in nature. Increased healthcare resource use is common among patients with frequent exacerbations, and exacerbations are a major cause of the high 30-day hospital readmission rates associated with COPD.

Summary: This review provides a concise overview of the literature regarding the impact of COPD exacerbations on both the patient and the healthcare system, the recommendations for pharmacologic management of COPD, and the strategies employed to improve patient care and reduce hospitalizations and readmissions. COPD exacerbations significantly impact patients' health-related quality of life and disease progression; healthcare costs associated with severe exacerbation-related hospitalization range from $7,000 to $39,200. Timely and appropriate maintenance pharmacotherapy, particularly dual bronchodilators for maximizing bronchodilation, can significantly reduce exacerbations in patients with COPD. Additionally, multidisciplinary disease-management programs include pulmonary rehabilitation, follow-up appointments, aftercare, inhaler training, and patient education that can reduce hospitalizations and readmissions for patients with COPD.

Conclusion: Maximizing bronchodilation by the appropriate use of maintenance therapy, together with multidisciplinary disease-management and patient education programs, offers opportunities to reduce exacerbations, hospitalizations, and readmissions for patients with COPD.

Keywords: chronic obstructive pulmonary disease; exacerbations; hospitalizations; patient care.

Figure 1.

Updated GOLD classification of COPD severity. The GOLD guidelines updated in 2019 use exacerbation history and symptom burden to classify patient’s future exacerbation risk stratification (ABCD tool). However, the use of spirometry is vital to properly diagnose and gauge a prognosis for the disease. CAT = COPD Assessment Test, COPD = chronic obstructive pulmonary disease, GOLD = Global Initiative for Chronic Obstructive Lung Disease, mMRC = modified Medical Research Council, FEV₁ = forced expiratory volume in 1 second, FVC = forced vital capacity. Reproduced with permission from Global Initiative for Chronic Obstructive Lung Disease 2019 report (copyright © 2019 Global Initiative for Chronic Obstructive Lung Disease, Inc.).

Figure 2.

Recommended initial (A) and follow-up (B) treatment options. CAT = COPD assessment test, COPD = chronic obstructive pulmonary disease, eos = eosinophil counts (cells/µL), FEV₁ = forced expiratory volume in 1 second, ICS = inhaled corticosteroid, LABA = long-acting β ₂-agonist, LAMA = long-acting muscarinic antagonist, mMRC = modified Medical Research Council. Reproduced with permission from Global Initiative for Chronic Obstructive Lung Disease 2019 report (copyright © 2019 Global Initiative for Chronic Obstructive Lung Disease, Inc.).