Chronic Obstructive Pulmonary Disease Exacerbations

JADWIGA A. WEDZICHA is Professor of Respiratory Medicine at the University College London and Honorary Consultant Physician, Royal Free Hospital NHS Trust, London, UK. She received her M.D. from the University of London, London, UK. Dr. Wedzicha has a major interest in the causes, mechanisms, and impact of COPD exacerbations and has published extensively on this topic. She also is an expert on home oxygen therapy and non-invasive ventilation in COPD patients. Dr. Wedzicha has chaired the British Thoracic Society (BTS) working group on home oxygen therapy, is currently chairing the BTS Home Oxygen Guidelines Group, and is a member of the Department of Health’s External Stakeholders Advisory Group for the Home Oxygen Service. She was a member of the Guideline Development Group for the NICE COPD guidelines and the External Reference Group (ERG) of the COPD National Service Framework (NSF). Dr. Wedzicha directs an active internationally recognized research group into aspects of COPD exacerbations with major grant funding. She is currently Editor-in-Chief of the respiratory journal Thorax, a member of the British Medical Journal advisory board, and an editorial board member for a number of international journals. FERNANDO J. MARTINEZ is Medical Director of Pulmonary Diagnostic Services; Pulmonary Director of the Cough/Dyspnea Clinic; Associate Director of Bronchoscopy Service; Director of the Lung Volume Reduction Program; Professor of Pulmonary and Critical Care Medicine; and Co-Medical Director of the Lung Transplantation Program, the University of Michigan Health System, Ann Arbor, Michigan, USA. Dr. Martinez received his M.D. from the University of Florida School of Medicine, Gainesville, Florida, USA. From 2002 to the present, he has been named on both the national and Midwest "Best Doctors in America" lists, in addition to "Metro Detroit’s Best Doctors" list. Dr. Martinez is an active member of several professional organizations, including the American College of Chest Physicians, the American Thoracic Society, and the American Association of Cardiovascular and Pulmonary Rehabilitation. He is Associate Editor of the American Journal of Respiratory and Critical Care Medicine, and he serves on the editorial and review boards of several other journal publications. Dr. Martinez is an accomplished author/contributor and invited lecturer, and has received numerous grants to research respiratory health and disease.

Part I: Introduction. Definitions and severity of COPD exacerbations. Epidemiology of COPD exacerbations. Differential diagnosis of COPD exacerbations. PART II: Mechanisms and Pathophysiology. Symptom changes at exacerbations. Airway pathology at exacerbations. Airway and systemic inflammatory markers at exacerbation. Physiological changes at exacerbations. Systemic consequences of COPD exacerbations. Mechanisms of respiratory failure at exacerbation. Role of respiratory viral infection at exacerbation. Do airway bacteria cause COPD exacerbations? Interactions of airway pathogens and inflammatory processes. Role of co-morbidity at COPD exacerbations. Environmental causes of exacerbations. Mechanisms and pathophysiological changes in alpha-1 AT deficiency exacerbations. Experimental models of COPD exacerbations. Comparison of asthma and COPD exacerbations. Part III: Impact of Exacerbations. Exacerbations and health status. Risk factors for hospital admission. Effect of exacerbations on disease progression and mortality. Health economic consequences of COPD exacerbations. Part IV: Management of the Acute Exacerbation. Use of bronchodilators and mucolytics at COPD exacerbations. Corticosteroids in the management of acute exacerbations. Antibiotic therapy at COPD exacerbations. Non invasive ventilatory support. Invasive ventilation and weaning at COPD exacerbation. Oxygen therapy at exacerbations. End of life issues and COPD exacerbations. Novel models of care for COPD exacerbations. Physiotherapy airway clearance at exacerbation. COPD exacerbation and pulmonary rehabilitation. Part V: Prevention of COPD Exacerbation. Pharmacological prevention of COPD exacerbations. Early intervention and self-management in exacerbation prevention. Immunological interventions. Home mechanical ventilation and oxygen therapy. Part VI: Issues for Studies of COPD Exacerbations. Design of trials for COPD exacerbations. Statistical considerations for COPD exacerbation trials. Future development in COPD exacerbations.