Expertentreffen COPD: Exazerbation der COPD^[1]

Zusammenfassung

Akute Verschlechterungen der chronisch obstruktiven Lungenerkrankung (COPD) galten über lange Zeit als vorübergehende, gelegentlich auch lebensbedrohliche Symptomverschlechterungen, die jedoch keinen Bezug zum Verlauf der Grunderkrankung haben. Erst Mitte des letzten Jahrzehnts wurde gezeigt, dass Patienten mit schweren, stationär behandlungsbedürftigen Exazerbationen in der Folge eine erheblich erhöhte Sterblichkeit aufweisen. Diese Einsicht konnte 2012 durch eine große, populationsbasierte Kohortenanalyse konsolidiert werden. Heute gilt die schwere Exazerbation als ein Hauptrisikofaktor für die Krankheitsprogression. In der vorliegenden Zusammenfassung einer Expertentagung im Februar 2017 wird der aktuelle Stand der Kenntnisse zur Exazerbation der COPD dargestellt. Er umfasst die pathogenetischen Prozesse, die auslösenden Mechanismen, die Charakteristika der Patientengruppen mit häufigen Exazerbationen und die Prädiktoren einer schlechten Überlebensprognose. Die Rolle von Komorbiditäten wird näher betrachtet. Die Darstellung der Pharmakotherapie der Exazerbation wird ergänzt durch eine ausführliche Betrachtung des ventilatorischen Supports. Zur Frage der Exazerbationsprävention werden die verfügbaren Pharmaka analysiert. Die Bedeutung nicht medikamentöser Präventivmaßnahmen wird im Einzelnen untersucht.

Abstract

Acute worsenings of chronic obstructive pulmonary disease (COPD) were for a long time regarded as transient deteriorations, although occasionally life-threatening. No connection to disease progression was recognized. Data emerging during the last decade showed that patients had a considerably worse survival outcome after severe exacerbations. This insight was consolidated in 2012 by a large population-based cohort analysis. At present, severe exacerbations are regarded as key risk factors for COPD disease progression. The present article summarises the current knowledge on exacerbations of COPD, as delineated during an expert workshop in February 2017. It comprises pathogenic mechanisms, exacerbation triggers, the characteristics of frequent exacerbators, and the predictors of worse survival outcome. The role of comorbidities is considered more closely. The presentation of the pharmacotherapy of acute exacerbation is supplemented by an overview of ventilatory support. Finally, pharmacological and nonpharmacological preventive measures are summarised.

¹ Sponsor: Boehringer Ingelheim Pharma GmbH & Co KG

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