Special Issue "COPD Exacerbations"

A special issue of Medical Sciences (ISSN 2076-3271). This special issue belongs to the section "Pneumology and Respiratory Diseases".

Deadline for manuscript submissions: closed (31 March 2018)

Special Issue Editors

Guest Editor
Dr. Arturo Huerta, PhD, FCCP

Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona - Senior Specialist Emergency Medicine Department/ Medicine Section, Hospital Clinic of Barcelona, Barcelona.
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Interests: Pulmonary medicine; COPD; pneumonia
Guest Editor
Prof. Dr. Antoni Torres

Director Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona
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Interests: respiratory medicine; epidemiology; risk factors; outcome; treatment; prevention and pathogenetic mechanisms of respiratory infections; community-acquired pneumonia; intensive care

Special Issue Information

Dear Colleagues,

Chronic obstructive pulmonary disease (COPD) is the most common respiratory comorbidity in the world, and has a significant impact on morbidity and mortality. Exacerbations of COPD (AECOPD)—pneumonic and non-pneumonic—are important events in the natural history of a disease, because the number of episodes of hospitalization and costs associated with COPD are associated with these clinical events. These exacerbations involve predominately neutrophilic inflammation in response to aggression by external microorganisms, pollution and sometimes of unknown cause.

In recent years, literature has focused on the different phenotypes of exacerbation (including the Asthma–COPD overlap), the impact of other causal agents of AECOPD, such as fungi, the role of eosinophils (in stable and during exacerbations) and the impact of new inhaled molecules in the prevention of these events. There is also a concern on new therapies such as macrolides to prevent exacerbations, the role of microbiome and new evidence on the use of non-invasive ventilation and emerging multidrug-resistant microorganisms as etiologic agents.

In this Special Issue of Medical Sciences we will cover the latest evidence not only on the diagnosis, but also the novelties on therapeutics from top experts in the field.

Dr. Arturo Huerta
Prof. Antoni Torres
Guest Editors

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Keywords

  • Chronic obstructive pulmonary disease (COPD)
  • AECOPD
  • exacerbations

Published Papers (7 papers)

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Review

Open AccessReview
The Importance of Inhaler Adherence to Prevent COPD Exacerbations
Med. Sci. 2019, 7(4), 54; https://doi.org/10.3390/medsci7040054
Received: 19 March 2019 / Accepted: 25 March 2019 / Published: 1 April 2019
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Abstract
It has been shown that the better outcomes of chronic obstructive pulmonary disease (COPD) are closely associated with adherence to drug therapy, independent of the treatment administered. The clinical trial Towards a Revolution in COPD Health (TORCH) study clearly showed in a three [...] Read more.
It has been shown that the better outcomes of chronic obstructive pulmonary disease (COPD) are closely associated with adherence to drug therapy, independent of the treatment administered. The clinical trial Towards a Revolution in COPD Health (TORCH) study clearly showed in a three year follow up that patients with good adherence to their inhaler treatment presented a longer time before the first exacerbation, a lower susceptibility to exacerbation and lower all-cause mortality. The Latin American Study of 24-h Symptoms in Chronic Obstructive Pulmonary Disease (LASSYC), a real-life study, evaluated the self-reported inhaler adherence in COPD patients in seven countries in a cross-sectional non-interventional study and found that approximately 50% of the patients had good adherence, 30% moderate adherence and 20% poor adherence. Adherence to inhaler may be evaluated by the specific inhaler adherence questionnaire, the Test of Adherence to Inhalers (TAI). Several factors may predict the incorrect use of inhalers or adherence in COPD outpatient, including the number of devices and the daily dosing frequency. Ideally, patient education, simplicity of the device operation, the use of just one device for multiple medications and the best adaptation of the patient to the inhaler should guide the physician in prescribing the device. Full article
(This article belongs to the Special Issue COPD Exacerbations)
Open AccessReview
Ischemic Heart Disease during Acute Exacerbations of COPD
Med. Sci. 2018, 6(4), 83; https://doi.org/10.3390/medsci6040083
Received: 3 July 2018 / Revised: 10 September 2018 / Accepted: 20 September 2018 / Published: 25 September 2018
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Abstract
Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of acute cardiovascular events, and around 30% die from cardiovascular diseases. Recent data suggest an increased risk of myocardial infarction in the following days of a severe exacerbation of COPD. Disruption in [...] Read more.
Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of acute cardiovascular events, and around 30% die from cardiovascular diseases. Recent data suggest an increased risk of myocardial infarction in the following days of a severe exacerbation of COPD. Disruption in the balance during the exacerbation with tachycardia, increased inflammation and systemic oxidative stress as well as some other factors may confer an increased risk of subsequent cardiovascular events. A number of investigations may be useful to an early diagnosis, including electrocardiography, imaging techniques and blood test for biomarkers. Some drugs that have changed prognosis in the cardiovascular setting such as cardioselective beta-blockers may be underused in patients with COPD despite its demonstrated benefits. This review focuses on several aspects of exacerbation of COPD and cardiovascular events including epidemiology, possible mechanism, diagnosis and treatment. Full article
(This article belongs to the Special Issue COPD Exacerbations)
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Open AccessReview
Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PRO
Med. Sci. 2018, 6(3), 74; https://doi.org/10.3390/medsci6030074
Received: 12 July 2018 / Revised: 2 September 2018 / Accepted: 4 September 2018 / Published: 11 September 2018
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Abstract
In an era of precision medicine, it seems regressive that we do not use stratified approaches to direct treatment of oral corticosteroids during an exacerbation of chronic obstructive pulmonary disease (COPD). This is despite evidence suggesting that 40% of COPD patients have eosinophilic [...] Read more.
In an era of precision medicine, it seems regressive that we do not use stratified approaches to direct treatment of oral corticosteroids during an exacerbation of chronic obstructive pulmonary disease (COPD). This is despite evidence suggesting that 40% of COPD patients have eosinophilic inflammation and this is an indicator of corticosteroid response. Treatments with oral corticosteroids are not always effective and not without harm, with significant and increased risk of hyperglycemia, sepsis, and fractures. Eosinophils are innate immune cells with an incompletely understood role in the pathology of airway disease. They are detected at increased levels in some patients and can be measured using non-invasive methods during states of exacerbation and stable periods. Despite the eosinophil having an unknown mechanism in COPD, it has been shown to be a marker of length of stay in severe hospitalized exacerbations, a predictor of risk of future exacerbation and exacerbation type. Although limited, promising data has come from one prospective clinical trial investigating the eosinophil as a biomarker to direct systemic corticosteroid treatment. This identified that there were statistically significant and clinically worsened symptoms in patients with low eosinophil levels who were prescribed prednisolone, demonstrating the potential utility of the eosinophil. In an era of precision medicine our patients’ needs are best served by accurate diagnosis, correct identification of maximal treatment response and the abolition of harm. The peripheral blood eosinophil count could be used towards reaching these aims. Full article
(This article belongs to the Special Issue COPD Exacerbations)
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Open AccessReview
Care Bundles after Discharging Patients with Chronic Obstructive Pulmonary Disease Exacerbation from the Emergency Department
Med. Sci. 2018, 6(3), 63; https://doi.org/10.3390/medsci6030063
Received: 20 June 2018 / Revised: 2 August 2018 / Accepted: 6 August 2018 / Published: 7 August 2018
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Abstract
Chronic obstructive pulmonary disease (COPD) is the second leading cause of emergency department (ED) admissions to hospital, and nearly a third of patients with acute exacerbation (AE) of COPD are re-admitted to hospital within 28 days after discharge. It has been suggested that [...] Read more.
Chronic obstructive pulmonary disease (COPD) is the second leading cause of emergency department (ED) admissions to hospital, and nearly a third of patients with acute exacerbation (AE) of COPD are re-admitted to hospital within 28 days after discharge. It has been suggested that nearly a third of COPD admissions could be avoided through the implementation of evidence-based care interventions. A COPD discharge bundle is a set of evidence-based practices, aimed at improving patient outcomes after discharge from AE COPD; body of evidence supports the usefulness of discharge care bundles after AE of COPD, although there is a lack of consensus of what interventions should be implemented. On the other hand, the implementation of those interventions also involves different challenges. Important care gaps remain regarding discharge care bundles for patients with acute exacerbation of COPD discharged from EDs There is an urgent need for investigations to guide future implementation of care bundles for those patients discharged from EDs. Full article
(This article belongs to the Special Issue COPD Exacerbations)
Open AccessReview
Is It Time to Change the Definition of Acute Exacerbation of Chronic Obstructive Pulmonary Disease? What Do We Need to Add?
Med. Sci. 2018, 6(2), 50; https://doi.org/10.3390/medsci6020050
Received: 7 April 2018 / Revised: 10 June 2018 / Accepted: 11 June 2018 / Published: 14 June 2018
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Abstract
Acute exacerbations in chronic obstructive pulmonary disease (AECOPD) are associated with increased mortality, rate of hospitalization, use of healthcare resources, and have a negative impact on disease progression, quality of life and lung function of patients with chronic obstructive pulmonary disease (COPD). There [...] Read more.
Acute exacerbations in chronic obstructive pulmonary disease (AECOPD) are associated with increased mortality, rate of hospitalization, use of healthcare resources, and have a negative impact on disease progression, quality of life and lung function of patients with chronic obstructive pulmonary disease (COPD). There is an imperative need to homogenize the definition of AECOPD because the incidence of exacerbations has a significant influence or implication on treatment decision making, particularly in pharmacotherapy and could impact the outcome or change the statistical significance of a therapeutic intervention in clinical trials. In this review, using PubMed searches, we have analyzed the weaknesses and strengths of the different used AECOPD definitions (symptom-based, healthcare-based definition or the combinations of both), as well as the findings of the studies that have assessed the relationship of different biomarkers with the diagnosis, etiology and differential diagnosis of AECOPD and the progress towards the development of a more precise definition of COPD exacerbation. Finally, we have proposed a simple definition of AECOPD, which must be validated in future clinical trials to define its accuracy and usefulness in daily practice. Full article
(This article belongs to the Special Issue COPD Exacerbations)
Open AccessReview
Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD)? CON
Med. Sci. 2018, 6(2), 49; https://doi.org/10.3390/medsci6020049
Received: 18 April 2018 / Revised: 25 May 2018 / Accepted: 7 June 2018 / Published: 8 June 2018
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Abstract
The employment of systemic corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to improve airway limitation, decrease treatment failure and risk of relapse, and may improve symptoms in addition to decreasing the length of hospital [...] Read more.
The employment of systemic corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to improve airway limitation, decrease treatment failure and risk of relapse, and may improve symptoms in addition to decreasing the length of hospital stay. Nowadays, all clinical guidelines recommend systemic corticosteroids to treat moderate or severe COPD exacerbations. However, their use is associated with potential side effects, mainly hyperglycemia. In the era of precision medicine, the possibility of employing blood eosinophil count has emerged as a potential way of optimizing therapy. Issues regarding the intra-individual variability of blood eosinophil count determination, a lack of clear data regarding the real prevalence of eosinophilic acute exacerbations, the fact that previously published studies have demonstrated the benefit of systemic corticosteroids irrespective of eosinophil levels, and especially the fact that there is only one well-designed study justifying this approach have led us to think that we are not ready to use eosinophil count to guide treatment with systemic corticosteroids during acute exacerbations of COPD. Full article
(This article belongs to the Special Issue COPD Exacerbations)
Open AccessFeature PaperReview
Consolidation and Exacerbation of COPD
Med. Sci. 2018, 6(2), 44; https://doi.org/10.3390/medsci6020044
Received: 7 March 2018 / Revised: 30 May 2018 / Accepted: 31 May 2018 / Published: 1 June 2018
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Abstract
Twenty percent of chronic obstructive pulmonary disease (COPD) patients admitted to hospital because of an ‘exacerbation’ will have consolidation visible on a chest X-ray. The presence of consolidation is associated with higher mortality. Imperfect definitions of COPD exacerbation and pneumonia, and incomplete and [...] Read more.
Twenty percent of chronic obstructive pulmonary disease (COPD) patients admitted to hospital because of an ‘exacerbation’ will have consolidation visible on a chest X-ray. The presence of consolidation is associated with higher mortality. Imperfect definitions of COPD exacerbation and pneumonia, and incomplete and imperfect diagnostic tests, have resulted in a debate about whether these episodes are best thought of as ‘exacerbation with consolidation’ or ‘pneumonia in a person with COPD’. With the current views that exacerbations are not all identical, and that they can be ‘phenotyped’ to identify episodes with different prognosis and treatment response, perhaps these episodes are best-considered a phenotype of exacerbation. Whatever the terminology, the important clinical message is to recognise that those with consolidation have higher mortality, and likely different responses to treatment. Full article
(This article belongs to the Special Issue COPD Exacerbations)
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