Prevention of exacerbations

A decrease in the number of exacerbations experienced by patients is still a major unmet need in COPD.

Many COPD patients experience periodic worsening of their symptoms reflecting an acute deterioration in lung mechanics¹ and airway inflammation secondary to viral and/or bacterial infection.^2,3 These exacerbations contribute to impaired health status,^4,5 increased hospitalisation costs⁶ and predict mortality.⁷

Exacerbations range from unreported increases in patients’ symptoms⁸ through to periods requiring ventilatory support. The treatment of acute episodes has changed little over the last two decades.  Medication originally intended for symptom reduction such as bronchodilator drugs (beta-agonists and anticholinergics), reduce the number of reported COPD exacerbations.⁹ There is also a large body of data suggesting that the same is true for inhaled corticosteroids.¹⁰

References

1. Stevenson NJ, Walker PP, Costello RW, et al. Lung mechanics and dyspnea during exacerbations of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2006;172:1510-1516.
2. Papi A, Bellettato CM, Braccioni F, et al. Infections and Airway Inflammation in Chronic Obstructive Pulmonary Disease Severe Exacerbations. Am J Respir Crit Care Med 2006;173:1114-1121.  
3. Sethi S, Maloney J, Grove L, et al. Airway inflammation and bronchial bacterial colonization in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2006;173:991-998.
4. Seemungal TA, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:1418–1422.
5. Spencer S, Calverley PM, Burge PS, et al. Impact of preventing exacerbations on deterioration of health status in COPD Eur Respir J 2004;23:698-702.
6. Andersson F, Borg S, Jannson SA, et al. The costs of exacerbations in chronic obstructive pulmonary disease. Respir Med 2002;96:700-708.
7. Soler-Cataluna JJ, Martinez-Garcia MA, Roman Sanchez P, et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005;60:925–931.
8. Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;161:1608–1613.
9. Scott S, Walker P & Calverley PM. COPD exacerbations. 4: Prevention. Thorax 2006;61:440–447.
10. Calverley PMA, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007;356:775–789.