Exacerbations in COPD: a personalised approach to care

Patients with chronic obstructive pulmonary disease (COPD) can have acute episodes of worsening symptoms, known generically as exacerbations, which are clinically relevant because they involve an acute deterioration of the patient’s health status, worsen the patient’s prognosis, and are the main cause of economic expenditure associated with COPD. 

However, whether these episodes are truly due to an exacerbation of the underlying disease or correspond to worsening symptoms due to any of the diseases that commonly coexist with COPD is difficult to ascertain. In fact, both possibilities can occur separately or in combination. In this context, it is worth noting that effective management of COPD reduces the incidence of exacerbations by around 25–30%, but that most episodes remain (70–75%). 6 To what extent are these remaining exacerbations due to other factors (ie, are patients misdiagnosed) or mechanisms of COPD not targeted by current preventive treatments? Addressing this question in future research is important to reduce or prevent the incidence and consequences of these exacerbations.