Chronic Obstructive Pulmonary Disease Exacerbations PDF

Preface

It is now recognized that exacerbations are a major cause of the global morbidity and mortality associated with chronic obstructive pulmonary disease (COPD). They are also a cause of hospital admission and readmission and thus lead to considerable health care costs. Following the observation in the late 1990s that exacerbations are an important determinant of health-related quality of life in COPD, there has been considerable interest in the study of exacerbations. Over the last few years, studies have shown that exacerbations contribute to disease progression and mortality and that they are an important outcome for new therapies in COPD.

For this book, we have assembled international experts, both clinicians and scientists with an interest in COPD exacerbations, to review critically the current literature and provide up-to-date reviews on the various issues as well as highlight the many controversies and bottlenecks in the study of exacerbations.

COPD exacerbations are episodes of worsening of symptoms, accompanied by inflammatory and physiological changes. In this book, we have firstly covered issues of definition, diagnosis, and epidemiology and then presented a number of chapters on the many diverse mechanisms, including the role of bacterial and viral infection to the development of respiratory failure, associated with COPD exacerbations, which are heterogeneous events. It is now recognized that systemic inflammation and comorbidity play a prominent role in COPD and affect exacerbation outcome. Environmental issues, including air pollution, are difficult to study, but there is considerable recent information on their relation to COPD exacerbation in this book.

Both management of the acute exacerbation and exacerbation prevention have been addressed in separate sections. We now have a wide variety of pharmacological and nonpharmacological interventions to treat and prevent exacerbations, yet many clinicians are confused about how to use these therapies and for which patients. The section on exacerbation management will also cover new models of care for COPD exacerbations, integration of home and hospital care for these patients, and, importantly, end-of-life issues. Studies investigating new therapies for either reducing severity or frequency of COPD exacerbations have proved problematic to design and often conduct, with specific statistical considerations, and we have addressed these issues in the last section of the book.

We know that you will very much enjoy reading this book and that it will stimulate many of you to further study this fascinating and important topic. In view of their significance, COPD exacerbations will be the subject of much future research and clinical trial activity. The book will be useful as a reference to all clinicians involved in the care of patients with COPD.

Finally, we would like to thank all the authors for agreeing to write the chapters and contributing to this high quality book. We also express our gratitude to Sandra Beberman and her team for allowing us to proceed with this project and supporting us throughout the commissioning and production.