Læknablaðið - 01.07.2015, Blaðsíða 22
362 LÆKNAblaðið 2015/101
ENgLISH SUMMArY
Chronic obstructive pulmonary disease is common and is associated
with high morbidity and mortality. It leads to huge costs in the health
care system. one of the resons is acute exacerbations that lead to
hospital admissions, increased medication use and other costly
operations. They can also lead to death. In this review we will discuss
the definition of acute exacerbation, causes and differential diagnosis.
Treatment will be discussed and ways to avoid repeated exacerbations.
Among ways to prevent acute exacerbations is drug treatment such
as inhaled long-acting bronchodilators, inhaled corticosteroids and
combination treatment. In selected cases antibiotics and antioxidants
can be helpful. Influenza and pneumococcal vaccinations are important
in addition to pulmonary rehabiliation. It is important to evaluate the role
of co-morbidities and treat those diseases also. Examples of comorbidi-
tes are coronary artery disease and heart failure but also anxiety and
depression.
acute exacerbations of chronic obstructive pulmonary disease – review
Gunnar Guðmundsson1
1Department of Respiratory Medicine, National University Hospital and Faculty of Medicine, University of Iceland
key words: chronic obstructive pulmonary disease, acute exacerbation, comorbidites, causes, treatment, prevention
Correspondence: Gunnar Guðmundsson, ggudmund@landspitali.is
Y F i R l i T S G R E i n
39. Gudmundsson G, Ulrik CS, Gislason T, Lindberg E,
Brøndum E, Bakke P, et al. Long-term survival in patients
hospitalized for chronic obstructive pulmonary disease: a
prospective observational study in the Nordic countries.
Int J Chron Obstruct Pulmon Dis 2012; 7: 71-6.
40. Singanayagam A, Schembri S, Chalmers JD. Predictors of
mortality in hospitalized adults with acute exacerbation of
chronic obstructive pulmonary disease. Ann Am Thorac
Soc 2013; 10: 81-9.
41. Gudmundsson G, Gislason T, Lindberg E, Hallin R, Ulrik
CS, Brøndum E, et al. Mortality in COPD patients dischar-
ged from hospital: the role of treatment and co-morbidity.
Resp Res 2006; 7: 109.
42. Chawla H, Bulathsinghala C, Tejada JP, Wakefield D,
ZuWallack R. Physical activity as a predictor of thirty-
day hospital readmission after a discharge for a clinical
exacerbation of chronic obstructive pulmonary disease.
Ann Am Thorac Soc 2014 8: 1203-9.
43. Godtfredsen N, Lam T, Hansel T, Leon M, Gray N, Dresler
C. COPD-related morbidity and mortality after smoking
cessation: status of the evidence. Eur Resp J 2008 32: 844-
53.
44. Criner GJ, Bourbeau J, Diekemper RL, Ouellette DR,
Goodridge D, Hernandez P, et al. Executive Summary:
Prevention of Acute Exacerbation of Chronic Obstructive
Pulmonary Disease: American College of Chest Physicians
and Canadian Thoracic Society Guideline. Chest 2014; 147:
883-93.
45. Han M, Martinez F. Pharmacotherapeutic approaches
to preventing acute exacerbations of chronic obstructive
pulmonary disease. Proc ATS 2011 8: 356-62.
46. Decramer M, Rutten-van Mölken M, Dekhuijzen P,
Troosters T, van Herwaarden, C et al. Effects of
N-acetylcysteine on outcomes in chronic obstructive
pulmonary disease (Bronchitis Randomized on NAC
Cost-Utility Study, BRONCUS): a randomized placebo-
controlled trial. Lancet 2005; 365: 1552-60.
47. Tse H, Raiteri L, Wong K, Yee K, Ng L, Wai K. High-dose
N-acetylcysteine in stable chronic obstructive pulmonary
disease: the 1-year, double-blind, randomized, placebo-
controlled HIACE study. Chest 2013 144: 106-18.
48. Du Q, Sun Y, Ding N, Lu L, Chen Y. Beta-blockers reduced
the risk of mortality and exacerbation in patients with
COPD: a meta-analysis of observational studies. PLoS
One. 2014 ;9(11):
49. Criner GJ, Connett JE, Aaron SD, Albert RK, Bailey WC,
Casaburi R, et al. COPD Clinical Research Network;
Canadian Institutes of Health Research. Simvastatin for
the prevention of exacerbations in moderate-to-severe
COPD.N Engl J Med 2014; 370: 2201-10.
50. Ingebrigtsen TS, Marott JL, Nordestgaard BG, Lange
P, Hallas J, Vestbo J. Statin use and exacerbations in
individuals with chronic obstructive pulmonary disease.
Thorax 2015; 70: 33-40.
51. Albert R, Connett J, Bailey W, Casaburi R, Cooper J Jr,
Criner G, et al. Azithromycin for prevention of exacerba-
tions of COPD. N Eng J Med 2011; 365: 689-98.
52. Halldorsson S, Gudjonsson T, Gottfredsson M, Singh
PK, Gudmundsson GH, Baldursson O. Azithromycin
maintains airway epithelial integrity during Pseudomonas
aeruginosa infectionAm J Respir Cell Mol Biol 2010; 42:
62-8.
53. Asgrimsson V, Gudjonsson T, Gudmundsson GH,
Baldursson O. Novel effects of azithromycin on tight
junction proteins in human airway epithelia. Antimicrob
Agents Chemother 2006; 50: 1805-12.
54. Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey
WC, Buist AS, et al. Effects of smoking intervention and
the use of an inhaled anticholingergic bronchodilator on
the rate of decline of FEV1. The Lung Health Study JAMA
1994; 272: 1497-1505.
55. Au DH, Bryson CL, Chien JW, Sun H, Udris EM, Evans LE,
Bradley KA. The effects of smoking cessation on the risk
of chronic obstructive pulmonary disease exacerbations. J
Gen Intern Med 2009; 24: 457-63.
56. Maddocks M, Kon SS, Singh SJ, Man WD. Rehabilitation
following hospitalization in patients with COPD: Can it
reduce readmissions? Respirology 2015; 20: 395-404
57. Holland AE. Physiotherapy management of acute
exacerbations of chronic obstructive pulmonary disease. J
Physiother 2014; 60: 181-18
58. Prescott EC, Almdal T, Mikkelsen KL, Tofteng CL,
Vestbo J, Lange P. Prognostic value of weight change in
chronic obstructive pulmonary disease: results from the
Copenhagen City Heart Study. Eur Resp J 2002; 20: 539-44.
59. Hallin R, Gudmundsson G, Suppli Ulrik C, Nieminen
MM, Gislason T, Lindberg E, et al. Nutritional status and
long-term mortality in hospitalised patients with chronic
obstructive pulmonary disease (COPD). Respir Med 2007;
101: 1954-60.
60. Gavish R, Levy A, Dekel OK, Karp E, Maimon N. The asso-
ciation between hospital readmission and pulmonologist
follow-up visits in patients with Chronic Obstructive
Pulmonary Disease. Chest 2015.