- CLASSIFICATIONS
- HOSPITALISATIONS AND PREMATURE DEATH
- QUALITY OF LIFE
- LUNG FUCTION
- HEART ATTACK AND STROKE
Exacerbations of COPD are episodes of acute respiratory symptom worsening often associated with increased local and systemic inflammation7
- According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2024), exacerbations can be:
-Mild
-Moderate
-Severe (requires hospitalisation or emergency room visit).7
- Progression of COPD may be accompanied by exacerbations.8
- It's estimated that up to 391 million people aged 30–79 years had COPD worldwide.9
- In ECLIPSE study, 71% of patients with COPD can experience at least one exacerbation within the first three years of diagnosis.10
EVERY NEW SEVERE EXACERBATION INCREASES THE RISK OF HOSPITALISATION AND DEATH.2,10
- Just one moderate exacerbation has been shown to increase the risk of hospitalisation by 21%.11
- COPD severity, and frequent and more severe exacerbations are all related to an increased risk of mortality.2
- According to a population-based cohort study of 4204 hospitalized COPD patients, 22% of hospital survivors died at one year after discharge.12
- The best predictor of exacerbations, across all GOLD stages, was a history of exacerbations.13
EXACERBATIONS ARE ASSOCIATED WITH AN IMPAIRMENT IN QUALITY OF LIFE,14 ANXIETY, AND DEPRESSION AMONG COPD PATIENTS.15
- Occurrence of COPD exacerbation is significantly associated with impairment in health-related quality of life. Greater impact was noted for moderate/severe exacerbations.14
- COPD has multiple co-morbidities, two of the most common and least-treated co-morbidities of COPD are anxiety and depression. Estimates of prevalence of anxiety and depression in COPD vary widely but are generally higher than those reported in some other advanced chronic diseases.16
JUST ONE COPD EXACERBATION CAN LEAD TO DECLINE IN LUNG FUNCTION.1
- A single moderate exacerbation has been associated with a 21% increased risk of future severe exacerbation, according to a 2018 Study11
- After the single exacerbation, the rate of decline in post-bronchodilator FEV1 and FVC almost doubled.1
SEVERITY AND FREQUENCY OF COPD EXACERBATIONS INCREASE THE RISK OF HEART FAILURE, MYOCARDIAL INFARCTION AND STROKE.2
- Cardiovascular diseases are a major cause of death in patients with COPD.17
- Among people with COPD, 30% die of cardiovascular disease.18
- According to a case-series study of 25,857 patients with COPD, there was an increased risk of MI following an exacerbation of COPD that is approximately double that present in patients with stable disease.
- For all patients with COPD the incidence rate of stroke events was 1.4 per 100 patients-years (40% increase).18
MANY PATIENTS MAY NOT BE RECEIVING GUIDELINE-RECOMMENDED LONG ACTING MAINTENANCE THERAPY FOLLOWING AN EXACERBATION. THIS CAN PUT A PATIENT AT INCREASED RISK OF FUTURE EXACERBATIONS, LEADING TO A CYCLE OF DECLINING HEALTH6,23,24
- Some observational studies suggest that more than half of patients do not receive appropriate maintenance therapy following an exacerbation 23,24
- Delaying the start of maintenance therapy by 30 days or more post-hospitalisation has been associated with an increased risk of future moderate to severe exacerbations. 17,27
MANY COPD EXACERBATIONS ARE UNREPORTED,WHICH NOT ONLY UNDERSTIMATES THEIR INCIDENCE, BUT MAY ALSO LEAD TO UNDER-TREATMENT AND POORER RECOVERY. IN ADDITION, A HIGH PROPORTION OF PATIENTS ARE UNAWARE OF THE IMPORTANCE OF A RAPID RESPONSE TO EXACERBATIONS, WHICH MAY BE NECESSARY TO ACHIEVE EARLY AND COMPLETE RESOLUTION OF SYMPTOMS AND RECOVERY OF LUNG FUNCTION.5
- Among a cohort of patients with COPD who had received instruction on reporting worsening symptoms and had regular clinic visits, only 50% of exacerbations were reported to the clinical team when the patient noticed worsening symptoms on 2 consecutive days.6
- In one patient survey, 39% of COPD patients took a ‘wait and see’ approach to exacerbations.5
MANY PATIENTS ADAPT TO THEIR SYMPTOMS, ACCEPTING THEIR CONDITION AS IF IT CAN’T, OR DOES NOT NEED TO, BE TREATED
- Non-adherence in patients with COPD is common and could contribute to adverse health outcomes, reduced quality of life and increased healthcare expenditures.28
- COPD patients are accustomed to frequent symptom changes, and this may explain a tendency to under-report exacerbations.29
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COPD-DRIVEN CARDIOPULMONARY
RISK FAST FACTS VIDEO
In this short video, John Hurst, Professor, Respiratory Medicine at University College London and honorary consultant at Royal Free London NHS Foundation Trust, summarizes the latest evidence on the cardiopulmonary burden of COPD. You’ll learn:
- 1How worsening COPD symptoms and exacerbations can lead to cardiopulmonary events and premature death
- 2What are the potential mechanisms of COPD-driven cardiopulmonary risk
- 3That it’s time to embed a preventative mindset: act by identifying patients at-risk and optimizing their management
HOW CAN I IDENTIFY PATIENTS MOST AT RISK?
EXACERBATIONS ARE FREQUENTLY UNDER-REPORTED BY PATIENTS AND CAN THEREFORE BE under-treated.3-6
THERE ARE COMMON RISK FACTORS THAT CAN HELP IDENTIFY PATIENTS AT RISK OF AN EXACERBATION, INCLUDING:
The best predictor of the future events is a history of exacerbation(s). In many patients, the course of the disease is punctuated by exacerbations, an acute worsening of symptoms which in severe cases can necessitate hospitalisation and even result in death.13
Patients with raised eosinophil counts are at higher risk of exacerbating24
Increasing risk of the future exacerbation associated with worsening of COPD symptoms- Frequent cough and/or dyspnea13
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function and poor outcomes for patients. Acute exacerbations are associated with accelerated declines in FEV1 in those with established COPD, particularly in those with mild (GOLD stage 1) disease and when the exacerbations are severe.25
Patients who next to their COPD, also suffered from asthma, blindness or low vision, coronary heart disease, depression, dyspepsia, heart failure, osteoporosis or osteopenia, peripheral vascular disease, or prostate disorders, had a higher risk of having frequent exacerbations compared to those who did not suffer from these comorbid conditions.26
Don’t wait until your PATIENTS’ next exacerbation
- Assess Patient Symptoms
- Prioritise self-management
- Regularly review medications
- Adopt patient language
- Use the flare-up checklist
During patient follow up visits, it is important to regularly talk with your patient about their symptoms, including any new or worsening ones as increasing symptoms are associated with an increased risk of exacerbations
It can be challenging for patients to know how to manage their COPD and adopt sustainable self-management skills. All patients should be given the tools and support to:
- Quit smoking7
- Maintain a healthy diet7
- Exercise7
- Understand the signs and symptoms of their disease7
In addition, patients with a high symptom burden or risk of exacerbation should be encouraged to take part in a pulmonary rehabilitation programme.7
Your patients may not pro-actively communicate changes to their symptoms during check-ups. New or worsening symptoms, and moderate or severe exacerbations, may necessitate a change in treatment.7 Conduct regular medication reviews to ensure patients are on the most appropriate therapy for them.
Many patients do not understand what COPD is, and more than half of patients are not familiar with words like “exacerbation”.7 When discussing COPD with your patients, adopting a shared language and using terms such as “attack” or “flare-up” can help patients to understand what has happened to them.
Talk to your patients about the importance of reporting exacerbations.
You can help patients identify and report their COPD exacerbations by downloading the Flare-up Checklist here.
IT’S NEVER TOO EARLY TO ACT ON COPD
PUT PREVENTION OF EXACERBATION AND EARLY DEATH AT THE CENTRE OF COPD MANAGEMENT
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Invalidation date : 11-11-2025
