Management of severe acute exacerbations of COPD: an updated narrative review

Background: Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status wi...

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Detalhes bibliográficos
Autores: Crisafulli, Ernesto, Barbeta, Enric, Ielpo, Antonella, Torres Martí, Antoni
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:2018
País:España
Recursos:Universidad de Barcelona
Repositório:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/133480
Acesso em linha:https://hdl.handle.net/2445/133480
Access Level:Acceso aberto
Palavra-chave:Malalties pulmonars obstructives cròniques
Antibiòtics
Oxigen
Respiració artificial
Chronic obstructive pulmonary diseases
Antibiotics
Oxygen
Artificial respiration
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spelling Management of severe acute exacerbations of COPD: an updated narrative reviewCrisafulli, ErnestoBarbeta, EnricIelpo, AntonellaTorres Martí, AntoniMalalties pulmonars obstructives cròniquesAntibiòticsOxigenRespiració artificialChronic obstructive pulmonary diseasesAntibioticsOxygenArtificial respirationBackground: Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. Main body: In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. Conclusion: Several treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs.BioMed Central2018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/133480Articles publicats en revistes (Medicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1186/s40248-018-0149-0Multidisciplinary Respiratory Medicine, 2018, vol. 13, num. 36https://doi.org/10.1186/s40248-018-0149-0cc-by (c) Crisafulli, Ernesto et al., 2018http://creativecommons.org/licenses/by/3.0/esinfo:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1334802025-07-25T16:43:42Z
dc.title.none.fl_str_mv Management of severe acute exacerbations of COPD: an updated narrative review
title Management of severe acute exacerbations of COPD: an updated narrative review
spellingShingle Management of severe acute exacerbations of COPD: an updated narrative review
Crisafulli, Ernesto
Malalties pulmonars obstructives cròniques
Antibiòtics
Oxigen
Respiració artificial
Chronic obstructive pulmonary diseases
Antibiotics
Oxygen
Artificial respiration
title_short Management of severe acute exacerbations of COPD: an updated narrative review
title_full Management of severe acute exacerbations of COPD: an updated narrative review
title_fullStr Management of severe acute exacerbations of COPD: an updated narrative review
title_full_unstemmed Management of severe acute exacerbations of COPD: an updated narrative review
title_sort Management of severe acute exacerbations of COPD: an updated narrative review
dc.creator.none.fl_str_mv Crisafulli, Ernesto
Barbeta, Enric
Ielpo, Antonella
Torres Martí, Antoni
author Crisafulli, Ernesto
author_facet Crisafulli, Ernesto
Barbeta, Enric
Ielpo, Antonella
Torres Martí, Antoni
author_role author
author2 Barbeta, Enric
Ielpo, Antonella
Torres Martí, Antoni
author2_role author
author
author
dc.subject.none.fl_str_mv Malalties pulmonars obstructives cròniques
Antibiòtics
Oxigen
Respiració artificial
Chronic obstructive pulmonary diseases
Antibiotics
Oxygen
Artificial respiration
topic Malalties pulmonars obstructives cròniques
Antibiòtics
Oxigen
Respiració artificial
Chronic obstructive pulmonary diseases
Antibiotics
Oxygen
Artificial respiration
description Background: Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. Main body: In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. Conclusion: Several treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs.
publishDate 2018
dc.date.none.fl_str_mv 2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/133480
url https://hdl.handle.net/2445/133480
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1186/s40248-018-0149-0
Multidisciplinary Respiratory Medicine, 2018, vol. 13, num. 36
https://doi.org/10.1186/s40248-018-0149-0
dc.rights.none.fl_str_mv cc-by (c) Crisafulli, Ernesto et al., 2018
http://creativecommons.org/licenses/by/3.0/es
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Crisafulli, Ernesto et al., 2018
http://creativecommons.org/licenses/by/3.0/es
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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