Prevention of COPD exacerbation: A fundamental challenge

Introduction. - Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a cause of suffering for patients and a burden for healthcare systems and society. Their prevention represents individual and collective challenge. The present article is based on the work of a group of experts who met on 5th and 6th May 2011 and seeks to highlight the importance of AECOPD. State of the art. - In the absence of easily quantifiable criteria, the definition of AECOPD varies in the literature, making identification difficult and affecting interpretation of study results. Exacerbations increase mortality and risk of cardiovascular disease. They also increase the risk of developing further exacerbations, accelerate the decline in lung function and contribute to reduction in muscle mass. By limiting physical activity and affecting mental state (anxiety, depression), AECOPD are disabling and impair quality of life. They increase work absenteeism and are responsible for about 60% of the global cost of COPD. Perspectives. - Earlier identification with simple criteria, possibly associated to patient phenotyping, could be helpful in preventing hospitalization. Conclusions. - Given their immediate and delayed impact, AECOPD should not be trivialized or neglected. Their prevention is a fundamental issue. (C) 2012 Published by Elsevier Masson SAS on behalf of SPLF.