Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
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REVIEW ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 54-63

An overview of exacerbations of chronic obstructive pulmonary disease: Can tests of small airways' function guide diagnosis and management?


1 Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
2 Department of Lung Function and Sleep, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
3 Department of Respiratory Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
4 Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK

Correspondence Address:
Mr. Nowaf Y Alobaidi
Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2GW

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DOI: 10.4103/atm.ATM_323_19

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Chronic obstructive pulmonary disease (COPD) is common and debilitating. Most patients with COPD experience intermittent, acute deterioration in symptoms which require additional therapy, termed exacerbations. Exacerbations are prevalent in COPD and are associated with poor clinical outcomes including death, a faster decline in lung health, and a reduced quality of life. Current guidelines highlight the need to treat exacerbations promptly and then mitigate future risk. However, exacerbations are self-reported, difficult to diagnose and are treated with pharmacological therapies which have largely been unchanged over 30 years. Recent research has highlighted how exacerbations vary in their underlying cause, with specific bacteria, viruses, and cell types implicated. This variation offers the opportunity for new targeted therapies, but to develop these new therapies requires sensitive tools to reliably identify the cause, the start, and end of an exacerbation and assess the response to treatment. Currently, COPD is diagnosed and monitored using spirometric measures, principally the forced expiratory volume in 1 s and forced vital capacity, but these tests alone cannot reliably diagnose an exacerbation. Measures of small airways' function appear to be an early marker of COPD, and some studies have suggested that these tests might also provide physiological biomarkers for exacerbations. In this review, we will discuss how exacerbations of COPD are currently defined, stratified, monitored, and treated and review the current literature to determine if tests of small airways' function might improve diagnostic accuracy or the assessment of response to treatment.


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