martes, 6 de noviembre de 2018

Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD)

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By HH Patel, M.Pharm.Reviewed by Gaea Marelle Miranda, MSc

Chronic obstructive pulmonary disease (COPD) is an inflammatory condition characterized by difficulty in breathing, wheezing, and abnormal sputum production.

Doctor listening to the heartbeat of a patient with COPD.

Image Credit: Freedomz / Shutterstock

COPD occurs when there is obstruction of airflow to the lungs. Individuals with COPD are at an increased risk of developing other pulmonary conditions such as bronchitis and emphysema, and are vulnerable to several cardiac problems. In addition to the aforementioned symptoms, COPD patients also experience chest tightness, cyanosis (blue lips and nails), weight loss, and swelling in the lower extremities.

The most common causes of COPD are tobacco smoking and occupational exposure to harmful fumes and chemicals.

Acute exacerbations

As the name suggests, Acute Exacerbations of COPD (AECOPD) are acute episodes of breathlessness and sputum production. The condition may progress into an emergency situation if the patient becomes unable to breathe normally.

If not treated quickly, AECOPD could result in complete respiratory failure. The patient may become unconscious or may go into coma due to lack of oxygen supply to the brain. The risk of other cardiac complications also rises, especially in elderly patients who have a certain amount of blockage in their blood vessels.

Triggers of AECOPD

Due to underlying pulmonary problems, COPD patients are more vulnerable to harmful stimuli which can trigger AECOPD. These may include:

Cigarette smoke
Industrial smoke
Toxic byproducts of chemical reactions
Respiratory infections

Risk factors for AECOPD

Often referred to as ‘frequent exacerbators,’ some COPD patients are at a higher risk of suffering from AECOPD. Although the incidence of AECOPD in a subset of COPD patients has been unanimously found to be high, the exact cause has not been identified.

Several risk factors were identified as driving factors in determining AECOPD susceptibility. At present, scientists are also studying the genetic and phenotypic host characteristics associated with the condition, as well as AECOPD’s correlation with other progressive co-existing conditions, in order to understand the cause of frequent AECOPD episodes in certain individuals.

Effects of acute exacerbations on the prognosis of COPD

COPD is a limiting condition that drastically reduces patients’ quality of life. AECOPD further worsens the condition by significantly increasing morbidity and mortality.

It was empirically-observed that exacerbations result in poorer prognosis of the disease. With each episode of AECOPD, lung function gets significantly impaired compared to normal course COPD. This is associated with faster progression of COPD and steep decline in the quality of life of the patients.

Due to the need of intensive medical care and hospitalizations, AECOPD also poses additional economic burden on patients and their families.

Management of AECOPD

Ventilator assistance is the primary and immediate management approach for patients with AECOPD. Doctors also employ fast-onset bronchodilators and corticosteroids for treatment in the intensive care unit; however, the clinical validity of the approved doses and side effects of corticosteroids are still topics of debate among medical fraternity. If the cause of the infection is known, antibiotics are given to treat the underlying condition, thereby reducing the chances of further exacerbations.

Due to increased awareness about AECOPD, patients have now become more vigilant of their condition. Physicians have started including the risk assessment for AECOPD along with the battery of standard lung function tests, such as forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). An earlier identification of the patient as a frequent exacerbator can be of great help in terms of preparing for emergency situations and providing prophylactic relief.

Further research

A meta-analysis was conducted covering 17 different antibiotics and 5,906 patients with AECOPD. Results showed that macrolide antibiotics had a high cure rate for AECOPD with low incidence of adverse events, while fluoroquinolones showed slightly higher incidence of adverse events with a similar clinical cure rate.

Tetracyclines were found to be more efficacious in terms of microbiological response rate. These results provide better understanding of the uses of specific antibiotics for a given medical condition. Active research is ongoing for acquiring further evidence in this aspect.