07/08. tbl. 101. árg. 2015

Acute exacerbations of chronic obstructive pulmonary disease – review

Bráð versnun á langvinnri lungnateppu - yfirlitsgrein

Chronic obstructive pulmonary disease is common and is associated with high morbidity and mortality. It leads to huge costs in the health care system. One of the resons is acute exacerbations that lead to hospital admissions, increased medication use and other costly operations. They can also lead to death. In this review we will discuss the definition of acute exacerbation, causes and differential diagnosis. Treatment will be discussed and ways to avoid repeated exacerbations. Among ways to prevent acute exacerbations is drug treatment such as inhaled long-acting bronchodilators, inhaled corticosteroids and combination treatment. In selected cases antibiotics and antioxidants can be helpful. Influenza and pneumococcal vaccinations are important in addition to pulmonary rehabiliation. It is important to evaluate the role of co-morbidities and treat those diseases also. Examples of comorbidites are coronary artery disease and heart failure but also anxiety and depression.

Picture 1. Effects of acute exacerbations on patients with chronic obstructive pulmonary disease.

Tables:

Table 1. Risk factors for acute exacerbations

Increasing age Longer duration of COPD
Severity of obstruction Colonization of airways
Prior history of inhaled COPD drug use Comorbidites
Chronic bronchial mucus production Poor health related quality of life
Productive cough and wheezing Prior history of exacerbations
Antibiotic or systemic steroid use     


Table 2. Selected comorbidities of COPD

Cardiovascular diseases Depression
Heart failure Anxiety
Pulmonary hypertension Gastroesophageal reflux
Pulmonary embolism Diabetes mellitus
Osteoporosis Sleep disturbances


Table 3. Causes of infection in AECOPD

Bakteria Tíðni
Hemofilus influenzae 20-30%
Streptokokkus pneumoniae 10-15%
Moraxella cataralis 10-15%
Pseudomonas aeruginosa 5-10%
Viruses  
Rhinovirus 10-25%
Parainfluensavirus 5-10%
Influensuvirus 5-10%
Respiratory syncytial virus 5-10%


Table 4. Treatments that can prevent acute exacerbations of chronic obstructive pulmonary disease

Pharmacological Nonpharmacological
Long acting bronchodilators Tobacco cessation
Inhaled corticosteroids Influenza vaccination
Antioxidants Pnumococcal vaccination
Antibiotics Pulmonary rehabilitation
Betablockers if indicated for comorbidities Nutritional assessment

 









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