Acute Exacerbations of Chronic Obstructive Pulmonary Disease PDF

PREFACE

Chronic obstructive pulmonary disease is a major health problem. It is the fourth leading cause of morbidity and mortality worldwide, and further increases in the prevalence and mortality of the disease can be predicted in the coming years. COPD is characterized by chronic inflammation throughout the airways, parenchyma, and pulmonary vasculature. These disturbances lead to airflow limitation that is not fully reversible and to a variety of symptoms such as productive cough and dyspnea. COPD is often associated with acute exacerbations of symptoms, an important hallmark of the disease. The economic and social burden of acute exacerbations of COPD is extremely high because management often requires hospital and, occasionally, intensive care unit admissions. This is particularly true in advanced stages of the disease as both the frequency and impact of acute exacerbations increase. The diagnosis and management of acute exacerbation of the disease are not always simple; they require a fair amount of medical knowledge and sophisticated approaches. Acute exacerbations of COPD have become a focal point for both researchers and clinicians, and a substantial amount of new information about exacerbations has been accumulated.

This book deals with all aspects of acute exacerbations of COPD, beginning with a chapter that defines it and ending with one that details future research. Each chapter focuses on the state of the art regarding a particular subject, summarizing and expanding the corpus of knowledge. Many internationally renowned experts have participated in this project and we are profoundly grateful to them for their efforts.

The book is divided into nine parts. Part One deals with the definition, epidemiology and economic burden of acute exacerbations of COPD. The effect of acute exacerbation on the natural history of the disease is also reviewed. Part Two includes topics related to pathophysiology, pathology, and biomarkers of acute exacerbations. Recent data indicate that acute exacerbations may reflect systemic disease and this issue is discussed as well. Parts Three and Four review the causes, which are not always obvious, the clinical spectrum, blood gas derangements, imaging, laboratory findings, and assessment of the severity of the acute exacerbations. The heart–lung interaction encountered during acute exacerbations and its influence on sleep, important but largely ignored issues, are also discussed, in addition to the decision-making process in patients with end-stage disease who present with acute exacerbations. Parts Five through Seven deal with the management of acute exacerbations either at home or in the hospital, including the management of patients in the intensive care unit. Reviews of new and old modes of therapy are also included. Special reference is made to the use of noninvasive mechanical ventilatory support as a means of avoiding intubation and its complications. Finally, Part Eight discusses the use of acute exacerbation as an outcome variable to test different therapeutic interventions, an issue that has important clinical and economic implications. The final chapter deals with future research, a hot topic in this era of limited resources for funding research.

This book will help readers understand many aspects of acute exacerbations of COPD. Furthermore, we hope this book will be provocative and stimulate additional research to expand our knowledge in this field.

Finally, we wish to thank Dr. Claude Lenfant for his guidance and support, as well as our wives, Penelope, Barbara, and Ioanna.