Abstract
Severe, acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are
a rapid deterioration of the respiratory symptoms of patients with COPD, requiring
hospital admission and escalation of pharmacological and nonpharmacological care including
the more severe cases of respiratory failure and admission to an intensive care unit
(ICU). These events severely impact patients' quality of life and prognosis. This
review will describe the nonantibiotic, pharmacological treatment options available
for critically ill patients with AECOPD. The aim of treatment is to alleviate symptoms,
improve patient's functional and respiratory status, reduce mortality, reduce the
risk or the duration of invasive mechanical ventilation, and prevent reexacerbations.
Inhaled bronchodilators (i.e., short-acting β2-agonists and anticholinergics) and
systemic corticosteroids are the main drugs used in the treatment of AECOPD. These
drugs are also used in the treatment of stable COPD and in the treatment of AECOPD
patients in the non-ICU or community setting. Other drugs are essentially only used
in the ICU setting such as inhaled anesthetic agents, ketamine, intravenous methylxanthines,
and magnesium. Finally, recently developed drugs, such as the specific phosphodiesterase-4
inhibitors, may play a role in the prevention of relapsing AECOPD following a critical
event than the treatment of the exacerbation itself. Although they significantly improve
the survival of critically ill patients with AECOPD, none of available drugs, alone
or combined, is able to significantly modify the prognosis of patients with COPD.
This remains an open challenge for the current and future generations of researchers
and clinicians.
Keywords
AECOPD - severe COPD exacerbation - pharmacological treatment COPD - bronchodilators
- corticosteroids - roflumilast
