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Exacerbations of chronic obstructive pulmonary disease.

Abstract Exacerbations of chronic obstructive pulmonary disease (COPD) cause morbidity, hospital admissions, and mortality, and strongly influence health-related quality of life. Some patients are prone to frequent exacerbations, which are associated with considerable physiologic deterioration and increased airway inflammation. About half of COPD exacerbations are caused or triggered primarily by bacterial and viral infections (colds, especially from rhinovirus), but air pollution can contribute to the beginning of an exacerbation. Type 1 exacerbations involve increased dyspnea, sputum volume, and sputum purulence; Type 2 exacerbations involve any two of the latter symptoms, and Type 3 exacerbations involve one of those symptoms combined with cough, wheeze, or symptoms of an upper respiratory tract infection. Exacerbations are more common than previously believed (2.5-3 exacerbations per year); many exacerbations are treated in the community and not associated with hospital admission. We found that about half of exacerbations were unreported by the patients, despite considerable encouragement to do so, and, instead, were only diagnosed from patients' diary cards. COPD patients are accustomed to frequent symptom changes, and this may explain their tendency to underreport exacerbations. COPD patients tend to be anxious and depressed about the disease and some might not seek treatment. At the beginning of an exacerbation physiologic changes such as decreases in peak flow and forced expiratory volume in the first second (FEV(1)) are usually small and therefore are not useful in predicting exacerbations, but larger decreases in peak flow are associated with dyspnea and the presence of symptomatic upper-respiratory viral infection. More pronounced physiologic changes during exacerbation are related to longer exacerbation recovery time. Dyspnea, common colds, sore throat, and cough increase significantly during prodrome, indicating that respiratory viruses are important exacerbation triggers. However, the prodrome is relatively short and not useful in predicting onset. As colds are associated with longer and more severe exacerbations, a COPD patient who develops a cold should be considered for early therapy. Physiologic recovery after an exacerbation is often incomplete, which decreases health-related quality of life and resistance to future exacerbations, so it is important to identify COPD patients who suffer frequent exacerbations and to convince them to take precautions to minimize the risk of colds and other exacerbation triggers. Exacerbation frequency may vary with the severity of the COPD. Exacerbation frequency may or may not increase with the severity of the COPD. As the COPD progresses, exacerbations tend to have more symptoms and take longer to recover from. Twenty-five to fifty percent of COPD patients suffer lower airway bacteria colonization, which is related to the severity of COPD and cigarette smoking and which begins a cycle of epithelial cell damage, impaired mucociliary clearance, mucus hypersecretion, increased submucosal vascular leakage, and inflammatory cell infiltration. Elevated sputum interleukin-8 levels are associated with higher bacterial load and faster FEV(1) decline; the bacteria increase airway inflammation in the stable patient, which may accelerate disease progression. A 2-week course of oral corticosteroids is as beneficial as an 8-week course, with fewer adverse effects, and might extend the time until the next exacerbation. Antibiotics have some efficacy in treating exacerbations. Exacerbation frequency increases with progressive airflow obstruction; so patients with chronic respiratory failure are particularly susceptible to exacerbation.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title respiratory care
Publication Year Start
%A Wedzicha, Jadwiga A.; Donaldson, Gavin C.
%T Exacerbations of chronic obstructive pulmonary disease.
%J Respiratory care, vol. 48, no. 12, pp. 1204-13; discussion 1213-5
%D 12/2003
%V 48
%N 12
%M eng
%B Exacerbations of chronic obstructive pulmonary disease (COPD) cause morbidity, hospital admissions, and mortality, and strongly influence health-related quality of life. Some patients are prone to frequent exacerbations, which are associated with considerable physiologic deterioration and increased airway inflammation. About half of COPD exacerbations are caused or triggered primarily by bacterial and viral infections (colds, especially from rhinovirus), but air pollution can contribute to the beginning of an exacerbation. Type 1 exacerbations involve increased dyspnea, sputum volume, and sputum purulence; Type 2 exacerbations involve any two of the latter symptoms, and Type 3 exacerbations involve one of those symptoms combined with cough, wheeze, or symptoms of an upper respiratory tract infection. Exacerbations are more common than previously believed (2.5-3 exacerbations per year); many exacerbations are treated in the community and not associated with hospital admission. We found that about half of exacerbations were unreported by the patients, despite considerable encouragement to do so, and, instead, were only diagnosed from patients' diary cards. COPD patients are accustomed to frequent symptom changes, and this may explain their tendency to underreport exacerbations. COPD patients tend to be anxious and depressed about the disease and some might not seek treatment. At the beginning of an exacerbation physiologic changes such as decreases in peak flow and forced expiratory volume in the first second (FEV(1)) are usually small and therefore are not useful in predicting exacerbations, but larger decreases in peak flow are associated with dyspnea and the presence of symptomatic upper-respiratory viral infection. More pronounced physiologic changes during exacerbation are related to longer exacerbation recovery time. Dyspnea, common colds, sore throat, and cough increase significantly during prodrome, indicating that respiratory viruses are important exacerbation triggers. However, the prodrome is relatively short and not useful in predicting onset. As colds are associated with longer and more severe exacerbations, a COPD patient who develops a cold should be considered for early therapy. Physiologic recovery after an exacerbation is often incomplete, which decreases health-related quality of life and resistance to future exacerbations, so it is important to identify COPD patients who suffer frequent exacerbations and to convince them to take precautions to minimize the risk of colds and other exacerbation triggers. Exacerbation frequency may vary with the severity of the COPD. Exacerbation frequency may or may not increase with the severity of the COPD. As the COPD progresses, exacerbations tend to have more symptoms and take longer to recover from. Twenty-five to fifty percent of COPD patients suffer lower airway bacteria colonization, which is related to the severity of COPD and cigarette smoking and which begins a cycle of epithelial cell damage, impaired mucociliary clearance, mucus hypersecretion, increased submucosal vascular leakage, and inflammatory cell infiltration. Elevated sputum interleukin-8 levels are associated with higher bacterial load and faster FEV(1) decline; the bacteria increase airway inflammation in the stable patient, which may accelerate disease progression. A 2-week course of oral corticosteroids is as beneficial as an 8-week course, with fewer adverse effects, and might extend the time until the next exacerbation. Antibiotics have some efficacy in treating exacerbations. Exacerbation frequency increases with progressive airflow obstruction; so patients with chronic respiratory failure are particularly susceptible to exacerbation.
%K Adrenal Cortex Hormones, Anti-Bacterial Agents, Bacterial Infections, Biomarkers, Disease Progression, Expectorants, Humans, Inflammation, Pulmonary Disease, Chronic Obstructive, Quality of Life, Virus Diseases
%P 1204
%L 13; discussion 1213-5
%W PHY
%G AUTHOR
%R 2003.......48.1204W

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pages="1204--13; discussion 1213-5",
keywords="Adrenal Cortex Hormones",
keywords="Anti-Bacterial Agents",
keywords="Bacterial Infections",
keywords="Biomarkers",
keywords="Disease Progression",
keywords="Expectorants",
keywords="Humans",
keywords="Inflammation",
keywords="Pulmonary Disease, Chronic Obstructive",
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keywords="Virus Diseases",
abstract="Exacerbations of chronic obstructive pulmonary disease (COPD) cause morbidity, hospital admissions, and mortality, and strongly influence health-related quality of life. Some patients are prone to frequent exacerbations, which are associated with considerable physiologic deterioration and increased airway inflammation. About half of COPD exacerbations are caused or triggered primarily by bacterial and viral infections (colds, especially from rhinovirus), but air pollution can contribute to the beginning of an exacerbation. Type 1 exacerbations involve increased dyspnea, sputum volume, and sputum purulence; Type 2 exacerbations involve any two of the latter symptoms, and Type 3 exacerbations involve one of those symptoms combined with cough, wheeze, or symptoms of an upper respiratory tract infection. Exacerbations are more common than previously believed (2.5-3 exacerbations per year); many exacerbations are treated in the community and not associated with hospital admission. We found that about half of exacerbations were unreported by the patients, despite considerable encouragement to do so, and, instead, were only diagnosed from patients' diary cards. COPD patients are accustomed to frequent symptom changes, and this may explain their tendency to underreport exacerbations. COPD patients tend to be anxious and depressed about the disease and some might not seek treatment. At the beginning of an exacerbation physiologic changes such as decreases in peak flow and forced expiratory volume in the first second (FEV(1)) are usually small and therefore are not useful in predicting exacerbations, but larger decreases in peak flow are associated with dyspnea and the presence of symptomatic upper-respiratory viral infection. More pronounced physiologic changes during exacerbation are related to longer exacerbation recovery time. Dyspnea, common colds, sore throat, and cough increase significantly during prodrome, indicating that respiratory viruses are important exacerbation triggers. However, the prodrome is relatively short and not useful in predicting onset. As colds are associated with longer and more severe exacerbations, a COPD patient who develops a cold should be considered for early therapy. Physiologic recovery after an exacerbation is often incomplete, which decreases health-related quality of life and resistance to future exacerbations, so it is important to identify COPD patients who suffer frequent exacerbations and to convince them to take precautions to minimize the risk of colds and other exacerbation triggers. Exacerbation frequency may vary with the severity of the COPD. Exacerbation frequency may or may not increase with the severity of the COPD. As the COPD progresses, exacerbations tend to have more symptoms and take longer to recover from. Twenty-five to fifty percent of COPD patients suffer lower airway bacteria colonization, which is related to the severity of COPD and cigarette smoking and which begins a cycle of epithelial cell damage, impaired mucociliary clearance, mucus hypersecretion, increased submucosal vascular leakage, and inflammatory cell infiltration. Elevated sputum interleukin-8 levels are associated with higher bacterial load and faster FEV(1) decline; the bacteria increase airway inflammation in the stable patient, which may accelerate disease progression. A 2-week course of oral corticosteroids is as beneficial as an 8-week course, with fewer adverse effects, and might extend the time until the next exacerbation. Antibiotics have some efficacy in treating exacerbations. Exacerbation frequency increases with progressive airflow obstruction; so patients with chronic respiratory failure are particularly susceptible to exacerbation.",
issn="0020-1324",
url="http://www.ncbi.nlm.nih.gov/pubmed/14651761",
language="eng"
}

%0 Journal Article
%T Exacerbations of chronic obstructive pulmonary disease.
%A Wedzicha, Jadwiga A.
%A Donaldson, Gavin C.
%J Respiratory care
%D 2003
%8 Dec
%V 48
%N 12
%@ 0020-1324
%G eng
%F Wedzicha2003
%X Exacerbations of chronic obstructive pulmonary disease (COPD) cause morbidity, hospital admissions, and mortality, and strongly influence health-related quality of life. Some patients are prone to frequent exacerbations, which are associated with considerable physiologic deterioration and increased airway inflammation. About half of COPD exacerbations are caused or triggered primarily by bacterial and viral infections (colds, especially from rhinovirus), but air pollution can contribute to the beginning of an exacerbation. Type 1 exacerbations involve increased dyspnea, sputum volume, and sputum purulence; Type 2 exacerbations involve any two of the latter symptoms, and Type 3 exacerbations involve one of those symptoms combined with cough, wheeze, or symptoms of an upper respiratory tract infection. Exacerbations are more common than previously believed (2.5-3 exacerbations per year); many exacerbations are treated in the community and not associated with hospital admission. We found that about half of exacerbations were unreported by the patients, despite considerable encouragement to do so, and, instead, were only diagnosed from patients' diary cards. COPD patients are accustomed to frequent symptom changes, and this may explain their tendency to underreport exacerbations. COPD patients tend to be anxious and depressed about the disease and some might not seek treatment. At the beginning of an exacerbation physiologic changes such as decreases in peak flow and forced expiratory volume in the first second (FEV(1)) are usually small and therefore are not useful in predicting exacerbations, but larger decreases in peak flow are associated with dyspnea and the presence of symptomatic upper-respiratory viral infection. More pronounced physiologic changes during exacerbation are related to longer exacerbation recovery time. Dyspnea, common colds, sore throat, and cough increase significantly during prodrome, indicating that respiratory viruses are important exacerbation triggers. However, the prodrome is relatively short and not useful in predicting onset. As colds are associated with longer and more severe exacerbations, a COPD patient who develops a cold should be considered for early therapy. Physiologic recovery after an exacerbation is often incomplete, which decreases health-related quality of life and resistance to future exacerbations, so it is important to identify COPD patients who suffer frequent exacerbations and to convince them to take precautions to minimize the risk of colds and other exacerbation triggers. Exacerbation frequency may vary with the severity of the COPD. Exacerbation frequency may or may not increase with the severity of the COPD. As the COPD progresses, exacerbations tend to have more symptoms and take longer to recover from. Twenty-five to fifty percent of COPD patients suffer lower airway bacteria colonization, which is related to the severity of COPD and cigarette smoking and which begins a cycle of epithelial cell damage, impaired mucociliary clearance, mucus hypersecretion, increased submucosal vascular leakage, and inflammatory cell infiltration. Elevated sputum interleukin-8 levels are associated with higher bacterial load and faster FEV(1) decline; the bacteria increase airway inflammation in the stable patient, which may accelerate disease progression. A 2-week course of oral corticosteroids is as beneficial as an 8-week course, with fewer adverse effects, and might extend the time until the next exacerbation. Antibiotics have some efficacy in treating exacerbations. Exacerbation frequency increases with progressive airflow obstruction; so patients with chronic respiratory failure are particularly susceptible to exacerbation.
%K Adrenal Cortex Hormones
%K Anti-Bacterial Agents
%K Bacterial Infections
%K Biomarkers
%K Disease Progression
%K Expectorants
%K Humans
%K Inflammation
%K Pulmonary Disease, Chronic Obstructive
%K Quality of Life
%K Virus Diseases
%U http://www.ncbi.nlm.nih.gov/pubmed/14651761
%P 1204-13; discussion 1213-5

PT Journal
AU Wedzicha, JA
   Donaldson, GC
TI Exacerbations of chronic obstructive pulmonary disease.
SO Respiratory care
JI Respir Care
PD Dec
PY 2003
BP 1204
EP 13; discussion 1213-5
VL 48
IS 12
LA eng
DE Adrenal Cortex Hormones; Anti-Bacterial Agents; Bacterial Infections; Biomarkers; Disease Progression; Expectorants; Humans; Inflammation; Pulmonary Disease, Chronic Obstructive; Quality of Life; Virus Diseases
AB Exacerbations of chronic obstructive pulmonary disease (COPD) cause morbidity, hospital admissions, and mortality, and strongly influence health-related quality of life. Some patients are prone to frequent exacerbations, which are associated with considerable physiologic deterioration and increased airway inflammation. About half of COPD exacerbations are caused or triggered primarily by bacterial and viral infections (colds, especially from rhinovirus), but air pollution can contribute to the beginning of an exacerbation. Type 1 exacerbations involve increased dyspnea, sputum volume, and sputum purulence; Type 2 exacerbations involve any two of the latter symptoms, and Type 3 exacerbations involve one of those symptoms combined with cough, wheeze, or symptoms of an upper respiratory tract infection. Exacerbations are more common than previously believed (2.5-3 exacerbations per year); many exacerbations are treated in the community and not associated with hospital admission. We found that about half of exacerbations were unreported by the patients, despite considerable encouragement to do so, and, instead, were only diagnosed from patients' diary cards. COPD patients are accustomed to frequent symptom changes, and this may explain their tendency to underreport exacerbations. COPD patients tend to be anxious and depressed about the disease and some might not seek treatment. At the beginning of an exacerbation physiologic changes such as decreases in peak flow and forced expiratory volume in the first second (FEV(1)) are usually small and therefore are not useful in predicting exacerbations, but larger decreases in peak flow are associated with dyspnea and the presence of symptomatic upper-respiratory viral infection. More pronounced physiologic changes during exacerbation are related to longer exacerbation recovery time. Dyspnea, common colds, sore throat, and cough increase significantly during prodrome, indicating that respiratory viruses are important exacerbation triggers. However, the prodrome is relatively short and not useful in predicting onset. As colds are associated with longer and more severe exacerbations, a COPD patient who develops a cold should be considered for early therapy. Physiologic recovery after an exacerbation is often incomplete, which decreases health-related quality of life and resistance to future exacerbations, so it is important to identify COPD patients who suffer frequent exacerbations and to convince them to take precautions to minimize the risk of colds and other exacerbation triggers. Exacerbation frequency may vary with the severity of the COPD. Exacerbation frequency may or may not increase with the severity of the COPD. As the COPD progresses, exacerbations tend to have more symptoms and take longer to recover from. Twenty-five to fifty percent of COPD patients suffer lower airway bacteria colonization, which is related to the severity of COPD and cigarette smoking and which begins a cycle of epithelial cell damage, impaired mucociliary clearance, mucus hypersecretion, increased submucosal vascular leakage, and inflammatory cell infiltration. Elevated sputum interleukin-8 levels are associated with higher bacterial load and faster FEV(1) decline; the bacteria increase airway inflammation in the stable patient, which may accelerate disease progression. A 2-week course of oral corticosteroids is as beneficial as an 8-week course, with fewer adverse effects, and might extend the time until the next exacerbation. Antibiotics have some efficacy in treating exacerbations. Exacerbation frequency increases with progressive airflow obstruction; so patients with chronic respiratory failure are particularly susceptible to exacerbation.
ER

PMID- 14651761
OWN - NLM
STAT- MEDLINE
DA  - 20031203
DCOM- 20040505
LR  - 20151119
IS  - 0020-1324 (Print)
IS  - 0020-1324 (Linking)
VI  - 48
IP  - 12
DP  - 2003 Dec
TI  - Exacerbations of chronic obstructive pulmonary disease.
PG  - 1204-13; discussion 1213-5
AB  - Exacerbations of chronic obstructive pulmonary disease (COPD) cause morbidity,
      hospital admissions, and mortality, and strongly influence health-related quality
      of life. Some patients are prone to frequent exacerbations, which are associated 
      with considerable physiologic deterioration and increased airway inflammation.
      About half of COPD exacerbations are caused or triggered primarily by bacterial
      and viral infections (colds, especially from rhinovirus), but air pollution can
      contribute to the beginning of an exacerbation. Type 1 exacerbations involve
      increased dyspnea, sputum volume, and sputum purulence; Type 2 exacerbations
      involve any two of the latter symptoms, and Type 3 exacerbations involve one of
      those symptoms combined with cough, wheeze, or symptoms of an upper respiratory
      tract infection. Exacerbations are more common than previously believed (2.5-3
      exacerbations per year); many exacerbations are treated in the community and not 
      associated with hospital admission. We found that about half of exacerbations
      were unreported by the patients, despite considerable encouragement to do so,
      and, instead, were only diagnosed from patients' diary cards. COPD patients are
      accustomed to frequent symptom changes, and this may explain their tendency to
      underreport exacerbations. COPD patients tend to be anxious and depressed about
      the disease and some might not seek treatment. At the beginning of an
      exacerbation physiologic changes such as decreases in peak flow and forced
      expiratory volume in the first second (FEV(1)) are usually small and therefore
      are not useful in predicting exacerbations, but larger decreases in peak flow are
      associated with dyspnea and the presence of symptomatic upper-respiratory viral
      infection. More pronounced physiologic changes during exacerbation are related to
      longer exacerbation recovery time. Dyspnea, common colds, sore throat, and cough 
      increase significantly during prodrome, indicating that respiratory viruses are
      important exacerbation triggers. However, the prodrome is relatively short and
      not useful in predicting onset. As colds are associated with longer and more
      severe exacerbations, a COPD patient who develops a cold should be considered for
      early therapy. Physiologic recovery after an exacerbation is often incomplete,
      which decreases health-related quality of life and resistance to future
      exacerbations, so it is important to identify COPD patients who suffer frequent
      exacerbations and to convince them to take precautions to minimize the risk of
      colds and other exacerbation triggers. Exacerbation frequency may vary with the
      severity of the COPD. Exacerbation frequency may or may not increase with the
      severity of the COPD. As the COPD progresses, exacerbations tend to have more
      symptoms and take longer to recover from. Twenty-five to fifty percent of COPD
      patients suffer lower airway bacteria colonization, which is related to the
      severity of COPD and cigarette smoking and which begins a cycle of epithelial
      cell damage, impaired mucociliary clearance, mucus hypersecretion, increased
      submucosal vascular leakage, and inflammatory cell infiltration. Elevated sputum 
      interleukin-8 levels are associated with higher bacterial load and faster FEV(1) 
      decline; the bacteria increase airway inflammation in the stable patient, which
      may accelerate disease progression. A 2-week course of oral corticosteroids is as
      beneficial as an 8-week course, with fewer adverse effects, and might extend the 
      time until the next exacerbation. Antibiotics have some efficacy in treating
      exacerbations. Exacerbation frequency increases with progressive airflow
      obstruction; so patients with chronic respiratory failure are particularly
      susceptible to exacerbation.
FAU - Wedzicha, Jadwiga A
AU  - Wedzicha JA
AD  - Academic Unit of Respiratory Medicine, St Bartholomew's and Royal London School
      of Medicine and Dentistry, Dominion House, St Bartholomew's Hospital, London EC1A
      7BE, United Kingdom. [email protected]
FAU - Donaldson, Gavin C
AU  - Donaldson GC
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Respir Care
JT  - Respiratory care
JID - 7510357
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Biomarkers)
RN  - 0 (Expectorants)
SB  - IM
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Bacterial Infections/complications/drug therapy
MH  - Biomarkers/analysis
MH  - Disease Progression
MH  - Expectorants/therapeutic use
MH  - Humans
MH  - Inflammation/etiology
MH  - Pulmonary Disease, Chronic Obstructive/complications/*diagnosis/drug
      therapy/*prevention & control
MH  - Quality of Life
MH  - Virus Diseases/complications
RF  - 58
EDAT- 2003/12/04 05:00
MHDA- 2004/05/07 05:00
CRDT- 2003/12/04 05:00
PST - ppublish
SO  - Respir Care. 2003 Dec;48(12):1204-13; discussion 1213-5.
TY  - JOUR
AU  - Wedzicha, Jadwiga A.
AU  - Donaldson, Gavin C.
PY  - 2003/Dec/
TI  - Exacerbations of chronic obstructive pulmonary disease.
T2  - Respir Care
JO  - Respiratory care
SP  - 1204
EP  - 13; discussion 1213-5
VL  - 48
IS  - 12
KW  - Adrenal Cortex Hormones
KW  - Anti-Bacterial Agents
KW  - Bacterial Infections
KW  - Biomarkers
KW  - Disease Progression
KW  - Expectorants
KW  - Humans
KW  - Inflammation
KW  - Pulmonary Disease, Chronic Obstructive
KW  - Quality of Life
KW  - Virus Diseases
N2  - Exacerbations of chronic obstructive pulmonary disease (COPD) cause morbidity, hospital admissions, and mortality, and strongly influence health-related quality of life. Some patients are prone to frequent exacerbations, which are associated with considerable physiologic deterioration and increased airway inflammation. About half of COPD exacerbations are caused or triggered primarily by bacterial and viral infections (colds, especially from rhinovirus), but air pollution can contribute to the beginning of an exacerbation. Type 1 exacerbations involve increased dyspnea, sputum volume, and sputum purulence; Type 2 exacerbations involve any two of the latter symptoms, and Type 3 exacerbations involve one of those symptoms combined with cough, wheeze, or symptoms of an upper respiratory tract infection. Exacerbations are more common than previously believed (2.5-3 exacerbations per year); many exacerbations are treated in the community and not associated with hospital admission. We found that about half of exacerbations were unreported by the patients, despite considerable encouragement to do so, and, instead, were only diagnosed from patients' diary cards. COPD patients are accustomed to frequent symptom changes, and this may explain their tendency to underreport exacerbations. COPD patients tend to be anxious and depressed about the disease and some might not seek treatment. At the beginning of an exacerbation physiologic changes such as decreases in peak flow and forced expiratory volume in the first second (FEV(1)) are usually small and therefore are not useful in predicting exacerbations, but larger decreases in peak flow are associated with dyspnea and the presence of symptomatic upper-respiratory viral infection. More pronounced physiologic changes during exacerbation are related to longer exacerbation recovery time. Dyspnea, common colds, sore throat, and cough increase significantly during prodrome, indicating that respiratory viruses are important exacerbation triggers. However, the prodrome is relatively short and not useful in predicting onset. As colds are associated with longer and more severe exacerbations, a COPD patient who develops a cold should be considered for early therapy. Physiologic recovery after an exacerbation is often incomplete, which decreases health-related quality of life and resistance to future exacerbations, so it is important to identify COPD patients who suffer frequent exacerbations and to convince them to take precautions to minimize the risk of colds and other exacerbation triggers. Exacerbation frequency may vary with the severity of the COPD. Exacerbation frequency may or may not increase with the severity of the COPD. As the COPD progresses, exacerbations tend to have more symptoms and take longer to recover from. Twenty-five to fifty percent of COPD patients suffer lower airway bacteria colonization, which is related to the severity of COPD and cigarette smoking and which begins a cycle of epithelial cell damage, impaired mucociliary clearance, mucus hypersecretion, increased submucosal vascular leakage, and inflammatory cell infiltration. Elevated sputum interleukin-8 levels are associated with higher bacterial load and faster FEV(1) decline; the bacteria increase airway inflammation in the stable patient, which may accelerate disease progression. A 2-week course of oral corticosteroids is as beneficial as an 8-week course, with fewer adverse effects, and might extend the time until the next exacerbation. Antibiotics have some efficacy in treating exacerbations. Exacerbation frequency increases with progressive airflow obstruction; so patients with chronic respiratory failure are particularly susceptible to exacerbation.
SN  - 0020-1324
UR  - http://www.ncbi.nlm.nih.gov/pubmed/14651761
ID  - Wedzicha2003
ER  - 
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