Management of Chronic Obstructive Pulmonary Disease (COPD) Exacerbations in Hospitalized Patients From Admission to Discharge: A Comprehensive Review of Therapeutic Interventions

Abstract

Chronic obstructive pulmonary disease (COPD) is a common and debilitating condition that often necessitates hospitalization for exacerbations. Since COPD exacerbations can cause significant morbidity and mortality, managing them is crucial for patient care. Effective management of COPD exacerbations is essential to prevent complications, as COPD exacerbations are associated with increased healthcare costs and decreased quality of life. This review aims to comprehensively discuss the management of COPD exacerbations, covering various pharmacologic and non-pharmacologic strategies. These include inhaled bronchodilators, systemic steroids, antibiotics, invasive and non-invasive ventilation, oxygen therapy, smoking cessation, immunization with pneumococcal vaccine, inhalers at discharge, pulmonary rehabilitation, long-term oxygen therapy (LTOT), ambulatory oxygen therapy, short-burst oxygen therapy, extracorporeal membrane oxygenation (ECMO), lung volume reduction surgery (LVRS), endobronchial procedures, and lung transplant. It is drawn upon various sources, including clinical studies, systemic reviews, and observational studies, to provide a comprehensive overview of current practices and identify areas for future research and innovation in managing COPD exacerbations. Addressing these areas of interest can improve patient outcomes and quality of life.

Keywords: chronic obstructive pulmonary disease exacerbation; chronic obstructive pulmonary disease(copd); clinical outcomes; copd exacerbation; copd: chronic obstructive pulmonary disease; invasive ventilation; non invasive ventilation; therapeutic interventions.

Figure 1. The GOLD classification of COPD

Reproduced under the terms of the Creative Commons Attribution license. GOLD: Global Initiative for Chronic Obstructive Lung Disease; FEV1: forced expiratory volume in 1 second; COPD: chronic obstructive pulmonary disease [11]

Figure 2. Initial pharmacologic treatment of COPD

Reproduced with permission under the Creative Commons Attribution License. CAT: COPD assessment test; ICS: inhaled corticosteroid; LABA: long-acting β2-agonist; LAMA: long-acting muscarinic antagonist; mMRC: modified Medical Research Council dyspnea scale [33]

Figure 3. Different types of NIV interfaces

Reproduced under the terms of the Creative Commons Attribution license. NIV: non-invasive ventilation [67]

Figure 4. The pathogenesis of COPD

Reproduced under the terms of the Creative Commons Attribution license. Dashed bars represent inhibitory effects. COPD: chronic obstructive pulmonary disease [86]

Figure 5. A typical extracorporeal membrane oxygenation circuit (ECMO)

Reproduced under the terms of the Commons Creative Attribution license. [130]

Figure 6. Endobronchial valves (Zephyr valve system, Pulmonx) (A) and intrabronchial valves (Spiration valve system, Spiration/Olympus) (B)

Reproduced under the terms of the Creative Commons Attribution license. [148]

Figure 7. Kaplan-Meier plot of survival of patients who underwent BLVR treatment and who did not.

Reproduced under the terms of the Commons Creative Attribution License. BLVR: bronchoscopic lung volume reduction; non-BLVR; non-bronchoscopic lung volume reduction; CI: confidence interval *BLVR: patients who underwent a bronchoscopic lung volume reduction treatment. Non-BLVR: patients who did not undergo a bronchoscopic lung volume reduction treatment. The confidence interval was 95%. [133]

Figure 8. Thirty-sixth Adult Lung and Heart-Lung Transplantation Report (2019) of the International Thoracic Organ Transplant Registry (ITOTR) of the International Society for Heart and Lung Transplantation (ISHLT)

Reproduced under the terms of the Creative Commons Attribution license. [132]