Navigation Links
Exacerbations in COPD: One thing leads to another

New research shows that individual exacerbations in chronic obstructive lung disease (COPD) themselves increase the likelihood of repeat exacerbations, even after five days of full, asymptomatic recoverybad news for patients with COPD, where each exacerbation can drive the progression of the disease.

"This concept that exacerbations are not random has important implication for the analysis of clinical trial data and identifies a specific high-risk period for recurrent exacerbation during which preventative interventions might be targeted," wrote lead author, John Hurst, M.D., of the Royal Free and University College Medical School, in London.

The results appeared in the first issue for March of the American Journal of Respiratory and Critical Care Medicine, a publication of the American Thoracic Society.

In patients with COPD, exacerbations are generally defined as an acute worsening of symptoms. Exacerbations in and of themselves are inherently dangerous and can lead to hospitalization and serious complications. But beyond their acute dangers, exacerbations drive lung function decline, and many patients never recover their baseline level of lung function after exacerbations. Prior to this research, however, exacerbations were assumed to be isolated events unrelated to one another despite observational data that suggested a dependency.

To test the validity of this assumption, which not only informs treatment plans for patients with COPD, but also forms the basis of research design and analysis, Dr. Hurst and colleagues analyzed daily symptom diaries that were kept for at least one year by 297 COPD patients, describing nearly 2,000 distinct exacerbation events. Two or more new or worsening symptoms, one of which must be "major" (e.g., dyspnea, more sputum, or a change in color of sputum) constituted an exacerbation, and after five days of symptoms reverting to baseline severity, the exacerbation was considered to be over. A second exacerbation occurring within an eight-week period was considered to be a recurrent exacerbation. The researchers further analyzed seasonality of exacerbations, comparing their winter (November to January) frequency with their summer (June-August) frequency.

In addition to the finding that exacerbations were clustered in time within individuals, the researchers found that they were significantly more common in the winter than the summer. They also noted that "isolated" exacerbations tended on average to be about 25 percent more severe than the first of serial exacerbations.

But most importantly, the researchers identified an eight-week period of time during which monitoring and follow-up is crucial to prevent or minimize further exacerbations in the COPD patient. "Our finding of a high-risk period for recurrent exacerbation may be important in guiding patient follow-up," wrote Dr. Hurst.

"The mechanisms of exacerbation recurrence remain unexplored, and it is unknown whether recurrence is due to persistence of an existing organism or to acquisition of a new one," noted Dr. Hurst. However, there are some clues that may guide future research. "The failure to eradicate bacteria with exacerbation therapy has been associated with an incomplete recovery in inflammatory markers and we have recently reported a relationship between elevated C-reactive protein during the recovery period of an initial exacerbation and shorter time to the next." Furthermore, the paper noted that "symptoms more typical of viral infection are significantly more common during isolated events."

"This knowledge is very important for physicians," wrote Shawn D. Aaron, M.D., of the Ottawa Health Research Institute, in Canada, in an editorial in the same issue of the journal. "Clinicians should now be aware that their patients with COPD who experience an exacerbation may be particularly 'brittle' during a subsequent eight-week period. Close monitoring and follow-up during this time would hopefully lead to earlier therapy for recurrent exacerbations that may improve clinical outcomes."


Contact: Keely Savoie
American Thoracic Society

Related medicine news :

1. A Biologic Drug Superior to Spiriva in Reducing COPD-Related Exacerbations Would Earn a Higher Patient Share in Europe Than in the U.S.
2. Long-term antibiotics reduce COPD exacerbations, raise questions
3. FDA Approves Advair(R) 250/50 for Reduction of Exacerbations in Patients With COPD
4. Philippine Birthing Centers Help New Mothers, Healthy Infants
5. Nothing But Nets and Union of Reform Judaism Help Save Lives in Kenya
6. Brez(R), the First Over-the-Counter, Intranasal Breathing Aid Clinically Proven to Reduce Primary Snoring, Debuts in Rite Aid Pharmacies
7. Sleep disordered breathing and obesity: Independent effects, causes
8. ING and Fit Miami Foundation Name Winners of ING Run For Something Better Student Essay Contest
9. Vicks VapoRub Linked to Infant Breathing Problems
10. Launches as the Internets New Go-To Resource for All Things Dental
11. Breathing easier
Post Your Comments:
(Date:10/13/2017)... ... October 13, 2017 , ... Many families have long-term insurance ... care insurance companies have a waiver for care if the client has a cognitive ... the family pays for care, is often waived, so the benefits from their insurance ...
(Date:10/13/2017)... ... October 13, 2017 , ... Talented ... the lowdown on sciatica in a new episode of "Success Files," which is ... events and innovation and investigates each subject in-depth with passion and integrity. , ...
(Date:10/12/2017)... ... October 12, 2017 , ... CitiDent and ... apnea using cutting-edge Oventus O2Vent technology. As many as 18 million Americans ... frequent cessation in breathing. Oral appliances can offer significant relief to about 75 ...
(Date:10/12/2017)... ... October 12, 2017 , ... Asante, a nationally ... care, have expanded their existing home health joint venture through an agreement, effective ... operating a joint venture home health company with Asante, delivering clinically integrated care, ...
(Date:10/12/2017)... ... ... On Saturday, October 21, the Health & Wellness Center at Florida Hospital ... for the American Heart Association Heart Walk. Teams of up to 10 people can ... their treadmills moving for 5 hours. Treadmills will start at 7:00 p.m. on Saturday, ...
Breaking Medicine News(10 mins):
(Date:9/22/2017)... -- AVACEN Medical (AVACEN) announced that its CE-Marked AVACEN ... with the widespread pain associated with fibromyalgia in the ... Essex, England commented, "I had difficulty ... sleep at all, tremendous pain, with every movement sending ... AVACEN 100] enough, how this has and is helping ...
(Date:9/18/2017)... KALAMAZOO, Mich. , Sept. 18, 2017 ... , and OptiMed Specialty Pharmacy of Kalamazoo, ... offer a strategic hub service that expedites and streamlines ... personal spirometer, Spiro PD 2.0, and wellness management services.  ... is a medical device used to measure lung function ...
(Date:9/12/2017)... and NEW YORK , Sept. 12, 2017 ... performance ratings for global supply chains, has published the first annual edition ... CSR performance of more than 20,400 companies evaluated by EcoVadis, based on ... 2015 and 2016. ... EcoVadis Global CSR Risk & Performance Index ...
Breaking Medicine Technology: