Chronic Obstructive Pulmonary Disease Exacerbations: Current Controversies

Exacerbations of chronic obstructive pulmonary disease (COPD) are characterised by acute worsening of dyspnoea, sometimes accompanied by cough and sputum production and increased sputum purulence. Exacerbations carry with them important clinical and economic consequences including lost work productivity, increased utilisation of health care resources, temporary or permanent reductions in lung function and exercise capacity, hospitalisation, and sometimes death. Significant unresolved controversies surround COPD exacerbations. Controversies can be broadly grouped into the following categories: 1) definition of exacerbations; 2) pathogenesis of exacerbations; 3) prediction of exacerbations and early intervention in individual patients; 4) the role of patient self-management and COPD action plans in treatment of exacerbations; and 5) use of antibiotics to treat outpatient exacerbations. This paper will review the current state of the art with respect to how we define, predict, and treat COPD exacerbations, along with controversies and challenge associated with optimal management of exacerbations.