Chronic Obstructive Pulmonary Disease Exacerbations

Part I: Introduction. Definitions and severity of COPD exacerbations. Epidemiology of COPD exacerbations. Differential diagnosis of COPD exacerbations. PART II: Mechanisms and Pathophysiology. Symptom changes at exacerbations. Airway pathology at exacerbations. Airway and systemic inflammatory markers at exacerbation. Physiological changes at exacerbations. Systemic consequences of COPD exacerbations. Mechanisms of respiratory failure at exacerbation. Role of respiratory viral infection at exacerbation. Do airway bacteria cause COPD exacerbations? Interactions of airway pathogens and inflammatory processes. Role of co-morbidity at COPD exacerbations. Environmental causes of exacerbations. Mechanisms and pathophysiological changes in alpha-1 AT deficiency exacerbations. Experimental models of COPD exacerbations. Comparison of asthma and COPD exacerbations. Part III: Impact of Exacerbations. Exacerbations and health status. Risk factors for hospital admission. Effect of exacerbations on disease progression and mortality. Health economic consequences of COPD exacerbations. Part IV: Management of the Acute Exacerbation. Use of bronchodilators and mucolytics at COPD exacerbations. Corticosteroids in the management of acute exacerbations. Antibiotic therapy at COPD exacerbations. Non invasive ventilatory support. Invasive ventilation and weaning at COPD exacerbation. Oxygen therapy at exacerbations. End of life issues and COPD exacerbations. Novel models of care for COPD exacerbations. Physiotherapy airway clearance at exacerbation. COPD exacerbation and pulmonary rehabilitation. Part V: Prevention of COPD Exacerbation. Pharmacological prevention of COPD exacerbations. Early intervention and self-management in exacerbation prevention. Immunological interventions. Home mechanical ventilation and oxygen therapy. Part VI: Issues for Studies of COPD Exacerbations. Design of trials for COPD exacerbations. Statistical considerations for COPD exacerbation trials. Future devel