Download PDF
Dtsch Med Wochenschr 2019; 144(01): 21-27
DOI: 10.1055/a-0723-4172
Dossier
© Georg Thieme Verlag KG Stuttgart · New York

COPD: Umgang mit Exazerbationen – Diagnostik, Therapie und Nachsorge

Exacerbations of Chronic Obstructive Pulmonary Disease – Diagnostic Approach, Management and Follow-up Care
Fabian Leo
,
Heike Menger
Further Information

Publication History

Publication Date:
02 January 2019 (online)

Also available at
    Permissions and Reprints

Abstract

Exacerbations are major events in the disease process in patients with chronic obstructive pulmonary disease (COPD). They have a negative effect on the quality of life and the progression of the disease. Frequent exacerbations are associated with increased mortality. In addition to the optimal therapy, the prevention of further exacerbations and the attention to concomitant diseases are prognostically crucial for the patients. In this review article, current recommendations for the diagnosis, therapy and follow-up care of COPD exacerbations are summarized.

Exazerbationen sind bedeutende Ereignisse im Krankheitsverlauf bei Patienten mit chronisch obstruktiver Lungenerkrankung (COPD). Sie wirken sich negativ auf die Lebensqualität und die Progression der Erkrankung aus. Häufige Exazerbationen sind mit einer erhöhten Mortalität assoziiert. Dieser Beitrag fasst die aktuellen Empfehlungen zur Diagnostik, optimalen Therapie und Prävention weiterer Exazerbationen zusammen.

Schlüsselwörter

chronisch obstruktive Lungenerkrankung - Exazerbation - Prognose - Nachsorge

Key words

chronic obstructive pulmonary disease - disease exacerbation - prognosis - follow-up care
 

  • Literatur

  • 1 Soler-Cataluna JJ, Martinez-Garcia MA, Roman Sanchez P. et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005; 60: 925-931 . doi:10.1136/thx.2005.040527
    CrossrefPubMedGoogle Scholar
  • 2 Vogelmeier C, Buhl R, Burghuber O. et al. Guideline for the Diagnosis and Treatment of COPD Patients – Issued by the German Respiratory Society and the German Atemwegsliga in Cooperation with the Austrian Society of Pneumology. Pneumologie 2018; 72: 253-308 . doi:10.1055/s-0043-125031
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Vogelmeier CF, Criner GJ, Martinez FJ. et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017; 195: 557-582 . doi:10.1164/rccm.201701-0218PP
    CrossrefPubMedGoogle Scholar
  • 4 Hurst JR, Vestbo J, Anzueto A. et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 2010; 363: 1128-1138 . doi:10.1056/NEJMoa0909883
    CrossrefPubMedGoogle Scholar
  • 5 Brusselle G, Pavord ID, Landis S. et al. Blood eosinophil levels as a biomarker in COPD. Respir Med 2018; 138: 21-31 . doi:10.1016/j.rmed.2018.03.016
    CrossrefPubMedGoogle Scholar
  • 6 Watz H, Tetzlaff K, Wouters EF. et al. Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids: a post-hoc analysis of the WISDOM trial. Lancet Respir Med 2016; 4: 390-398 . doi:10.1016/s2213-2600(16)00100-4
    CrossrefPubMedGoogle Scholar
  • 7 Keene JD, Jacobson S, Kechris K. et al. Biomarkers Predictive of Exacerbations in the SPIROMICS and COPDGene Cohorts. Am J Respir Crit Care Med 2017; 195: 473-481 . doi:10.1164/rccm.201607-1330OC
    CrossrefPubMedGoogle Scholar
  • 8 Hartl S, Lopez-Campos JL, Pozo-Rodriguez F. et al. Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit. Eur Respir J 2016; 47: 113-121 . doi:10.1183/13993003.01391-2014
    CrossrefPubMedGoogle Scholar
  • 9 Walters JA, Tan DJ, White CJ. et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; 1: CD001288. doi:10.1002/14651858.CD001288.pub4
    PubMedGoogle Scholar
  • 10 Walters JA, Tan DJ, White CJ. et al. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2018; 3: CD006897. doi:10.1002/14651858.CD006897.pub4
    PubMedGoogle Scholar
  • 11 Leuppi JD, Schuetz P, Bingisser R. et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 2013; 309: 2223-2231 . doi:10.1001/jama.2013.5023
    CrossrefPubMedGoogle Scholar
  • 12 Lin C, Pang Q. Meta-analysis and systematic review of procalcitonin-guided treatment in acute exacerbation of chronic obstructive pulmonary disease. Clin Respir J 2018; 12: 10-15 . doi:10.1111/crj.12519
    CrossrefPubMedGoogle Scholar
  • 13 Frat JP, Thille AW, Mercat A. et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015; 372: 2185-2196 . doi:10.1056/NEJMoa1503326
    CrossrefPubMedGoogle Scholar
  • 14 Westhoff M, Schonhofer B, Neumann P. et al. Noninvasive mechanical ventilation in acute respiratory failure. Pneumologie 2015; 69: 719-756 . doi:10.1055/s-0034-1393309
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Kunisaki KM, Dransfield MT, Anderson JA. et al. Exacerbations of chronic obstructive pulmonary disease and cardiac events: a post hoc cohort analysis from the SUMMIT randomized clinical trial. Am J Respir Crit Care Med 2018; 198: 51-57 . doi:10.1164/rccm.201711-2239OC
    CrossrefPubMedGoogle Scholar
  • 16 Lindenauer PK, Dharmarajan K, Qin L. et al. Risk Trajectories of readmission and death in the first year after hospitalization for chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2018; 197: 1009-1017 . doi:10.1164/rccm.201709-1852OC
    CrossrefPubMedGoogle Scholar
  • 17 Wedzicha JA, Banerji D, Chapman KR. et al. Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD. N Engl J Med 2016; 374: 2222-2234 . doi:10.1056/NEJMoa1516385
    CrossrefPubMedGoogle Scholar
  • 18 Wedzicha JA, Decramer M, Ficker JH. et al. Analysis of chronic obstructive pulmonary disease exacerbations with the dual bronchodilator QVA149 compared with glycopyrronium and tiotropium (SPARK): a randomised, double-blind, parallel-group study. Lancet Respir Med 2013; 1: 199-209 . doi:10.1016/s2213-2600(13)70052-3
    CrossrefPubMedGoogle Scholar
  • 19 Lipson DA, Barnacle H, Birk R. et al. FULFIL Trial: Once-daily triple therapy for patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2017; 196: 438-446 . doi:10.1164/rccm.201703-0449OC
    CrossrefPubMedGoogle Scholar
  • 20 Lipson DA, Barnhart F, Brealey N. et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med 2018; 378: 1671-1680 . doi:10.1056/NEJMoa1713901
    CrossrefPubMedGoogle Scholar
  • 21 Papi A, Vestbo J, Fabbri L. et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet 2018; 391: 1076-1084 . doi:10.1016/s0140-6736(18)30206-x
    CrossrefPubMedGoogle Scholar
  • 22 Singh D, Papi A, Corradi M. et al. Single inhaler triple therapy versus inhaled corticosteroid plus long-acting beta2-agonist therapy for chronic obstructive pulmonary disease (TRILOGY): a double-blind, parallel group, randomised controlled trial. Lancet 2016; 388: 963-973 . doi:10.1016/s0140-6736(16)31354-x
    CrossrefPubMedGoogle Scholar
  • 23 Vestbo J, Papi A, Corradi M. et al. Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial. Lancet 2017; 389: 1919-1929 . doi:10.1016/s0140-6736(17)30188-5
    CrossrefPubMedGoogle Scholar
  • 24 Martinez FJ, Rabe KF, Calverley PMA. et al. Determinants of response to roflumilast in severe COPD: Pooled analysis of two randomized trials. Am J Respir Crit Care Med 2018; May 15. DOI: 10.1164/rccm.201712-2493OC [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 25 Cazzola M, Rogliani P, Calzetta L. et al. Impact of mucolytic agents on COPD exacerbations: a pair-wise and network meta-analysis. COPD 2017; 14: 552-563 . doi:10.1080/15412555.2017.1347918
    CrossrefPubMedGoogle Scholar