Acute exacerbation of chronic obstructive pulmonary disease

An acute exacerbation of COPD is associated with increased frequency and severity of coughing. == Causes ==

As the lungs tend to be vulnerable organs due to their exposure to harmful particles in the air, several things can cause an acute exacerbation of COPD: • Respiratory infection, being responsible for approximately half of COPD exacerbations. Approximately half of these are due to viral infections and another half appears to be caused by bacterial infections. Common bacterial pathogens of acute exacerbations include Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Less common bacterial pathogens include Chlamydia pneumoniae and MRSA. Pathogens seen more frequently in patients with impaired lung function (FEV<35% of predicted) include Haemophilus parainfluenzae (after repeated use of antibiotics), Mycoplasma pneumoniae and gram-negative, opportunistic pathogens like Pseudomonas aeruginosa and Klebsiella pneumoniae. • Allergens, e.g., pollens, wood or cigarette smoke, pollution • Toxins, including a variety of different chemicals • Air pollution • Failing to follow a drug therapy program, e.g. improper use of an inhaler In one-third of all COPD exacerbation cases, the cause cannot be identified. ==Diagnosis==

The diagnostic criteria for acute exacerbation of COPD generally include a production of sputum that is purulent The definition of a COPD exacerbation is commonly described as "lost in translation", meaning that there is no universally accepted standard with regard to defining an acute exacerbation of COPD. Many organizations consider it a priority to create such a standard, as it would be a major step forward in the diagnosis and quality of treatment of COPD. ==Prevention==

Acute exacerbations can be partially prevented. Some infections can be prevented by vaccination against pathogens such as influenza and Streptococcus pneumoniae. Regular medication use can prevent some COPD exacerbations; long acting beta-adrenoceptor agonists (LABAs), long-acting anticholinergics, inhaled corticosteroids and low-dose theophylline have all been shown to reduce the frequency of COPD exacerbations. Other methods of prevention include: • Smoking cessation and avoiding dust, passive smoking, and other inhaled irritants • Yearly influenza and 5-year pneumococcal vaccinations • Regular exercise, appropriate rest, and healthy nutrition • Avoiding people currently infected with e.g. cold and influenza • Maintaining good fluid intake and humidifying the home, in order to help reduce the formation of thick sputum and chest congestion. ==Treatment==

Based on the severity different treatments may be used. In specific circumstances high flow oxygen however can be beneficial. Antibiotics and steroids appear useful in mild to severe disease. Medications • Inhaled bronchodilators open up the airways in the lungs. These include salbutamol and terbutaline (both β2-adrenergic agonists), and ipratropium (an anticholinergic). • Antibiotics are used if a bacterial infection is the suspected cause. • Theophylline is generally not recommended. There should also be a "care plan" in case of future exacerbations. Patients may watch for symptoms, such as shortness of breath, change in character or amount of mucus, and start self-treatment as discussed with a health care provider. This allows for treatment right away until a doctor can be seen. Antibiotics are often used but will only help if the exacerbation is due to an infection. Antibiotics are indicated when a patient notes increased sputum production, Mechanical ventilation can be invasive (endotracheal intubation) or non-invasive forms of ventilation such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP). ==Epidemiology==

The incidence varies depending on which definition is used, but definitions by Anthonisen et al. the typical COPD patient averages two to three AECB episodes per year. With a COPD prevalence of more than 12 million (possibly 24 million including undiagnosed ones) in the United States, there are at least 30 million incidences of AECB annually in the US. == References ==