Preventing exacerbations

Posted by: admin on: January 16, 2012

Updated international treatment guidelines confirm experts’ views that prevention of COPD exacerbations should be of equal importance to relieving daily symptoms.


  • International treatment guidelines – from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) – have advised that prevention of exacerbations should be a cornerstone of chronic obstructive pulmonary disease (COPD) management, placing equal emphasis on the management of future risk as it does on treatment of COPD symptoms.
  • Datuk Dr Hj Abdul Razak Muttalif, director of the Institute of Respiratory Medicine (IPR), comments:
    1. The treatment pattern in COPD is changing, as studies have shown that exacerbations or ‘lung attacks’ may have significant long-term damage on patients, increasing the risk of faster progression of the disease, and ultimately, mortality.
    2. There is a pressing need for patients and physicians to understand the importance of preventing exacerbations to help reduce future risk of attacks and disease progression.
  • Speaking to more than 250 physicians at a symposium during Asian Pacific Society of Respirology (APSR), in Shanghai, China, Prof Zhong Nanshan, head of the Guangzhou Institute of Respiratory Disease, stressed the need for physicians to help their patients understand the importance of preventing and reducing exacerbations.
  • Prof Zhong said, frequent exacerbations have been linked to faster disease progression and poorer health, including a more rapid decline in lung function and a higher risk of death.
  • Some patients are particularly susceptible to frequent exacerbations – namely those who suffer from chronic bronchitis and have a history of previous exacerbations – and these are the patients at high risk whom we need to focus most of our efforts on.
  • However, patients may not have a good understanding about the impact of exacerbations, neglect to report them and/or do not seek help until the disease has progressed to a more severe stage.
  • Compared to 75% of doctors who felt that a heart attack had a major long-term impact, only 47% of doctors felt the same towards an exacerbation.
  • At present, the anti-inflammatory treatments used for COPD are used in asthma as well, and are not specifically developed for COPD.
  • However, the inflammatory pattern in COPD is different from that in asthma, which may explain the different responses to medication seen in the two diseases.
  • Projected to become the third leading cause of death worldwide by 2030, COPD – also called emphysema or chronic bronchitis – is a progressive lung disease associated with an enhanced inflammatory response of the lung tissue to inhaled pollutants such as cigarette smoke and indoor use of wood or coal-burning stoves and heaters.
  • The enhanced inflammation causes structural changes and progressive narrowing of the airways, resulting in difficulty in breathing and serious long-term disability.
  • Exacerbations, also described as lung attacks, are episodes where patients experience an acute episode of worsening symptoms.
  • Frequent exacerbations can negatively impact on disease progression.
  • Many COPD patients experience two or more exacerbations per year, which indicate a higher risk of a more rapid deterioration and progression of the disease, unless something is done to prevent further recurring events.
  • There is evidence to show that patients who have been admitted to hospital with a COPD exacerbation are at a greater risk of dying within a year than patients that have been admitted to hospital with a heart attack.
  • Dr Razak added, respiratory illness is the main cause of visits to clinics and outpatient hospital clinics, and it is estimated that more than 50% of the male population are smokers, with higher rates in the rural areas than the urban areas.
  • According to the third National Health and Morbidity Survey, there is a 4-5% prevalence of COPD among Malaysians, which translates to approximately 448,000 cases, and 80-90% of these COPD cases are caused by smoking.
  • Many COPD patients, despite available therapies, continue to have exacerbations that may lead to deterioration in their condition, hospitalisation and/or death.
  • Thus, World COPD Day (Nov 16) is an excellent platform to raise awareness of this long-term life-threatening disease so that patients are better informed to take action to safeguard his or her lung health.
  • In recent years, research has unveiled a new class of drugs that targets COPD inflammation. It is a selective inhibitor of PDE4 (phosphodiesterase 4) which acts differently from bronchodilators, by treating the underlying inflammation associated with COPD.
  • Clinical trials have shown that PDE4 significantly reduces exacerbations when added to bronchodilator therapy.
  • GOLD recently also included PDE4 inhibitors as a new treatment option in its latest COPD management guidelines.

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