From the Guidelines
The most common cause of Chronic Obstructive Pulmonary Disease (COPD) exacerbation is respiratory tract infections, particularly those caused by viruses and bacteria. According to the most recent and highest quality study, respiratory tract infections are the most common precipitating factors for COPD exacerbations 1. The study highlights that exacerbations can be precipitated by several factors, but the most common causes are respiratory tract infections. This is consistent with other studies, which have also identified respiratory tract infections as a major trigger for COPD exacerbations 1.
Key Points
- Respiratory tract infections, including viral and bacterial infections, are the most common cause of COPD exacerbations
- Viral infections, such as rhinovirus, influenza, and respiratory syncytial virus, account for a significant proportion of COPD exacerbations
- Bacterial infections, commonly involving Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis, are also a major cause of COPD exacerbations
- Air pollution, non-adherence to maintenance medications, exposure to allergens, and sudden weather changes are other important causes of COPD exacerbations
Prevention and Management
Patients with COPD should receive annual influenza vaccinations, pneumococcal vaccines, and maintain good hand hygiene to prevent infections 1. They should also adhere strictly to prescribed maintenance medications, such as long-acting bronchodilators and inhaled corticosteroids, to reduce the risk of exacerbations. These preventive measures are crucial because each exacerbation can accelerate lung function decline and increase mortality risk, with respiratory infections triggering inflammatory cascades that worsen airway obstruction and increase mucus production.
Treatment
The goal of treatment for COPD exacerbations is to minimize the negative impact of the current exacerbation and to prevent subsequent events 1. Short-acting inhaled β2-agonists, with or without short-acting anticholinergics, are recommended as the initial bronchodilators to treat an acute exacerbation. Systemic corticosteroids and antibiotics, when indicated, can also be used to treat COPD exacerbations. Non-invasive ventilation (NIV) should be the first mode of ventilation used to treat acute respiratory failure.
From the Research
Causes of COPD Exacerbation
- Respiratory viruses and bacteria are the main causes of COPD exacerbations, with rhinovirus being the most frequently detected virus 2, 3, 4, 5
- Noninfective environmental factors may also play a role in some patients 4
- Bacterial infection is a significant contributor to COPD exacerbations, with a large range of bacteria present in the lower respiratory tract 6
Role of Infection in COPD Exacerbations
- Respiratory viruses are detected in 37% of exacerbations, with rhinovirus being the most common infecting agent 5
- Bacteria are also frequently detected in COPD exacerbations, with some studies suggesting that they may be present in the lower respiratory tract even in stable COPD patients 6
- Dual infections, where more than one virus is detected, are only seen in patients with acute exacerbations of COPD 5
Prevention and Treatment of COPD Exacerbations
- Several pharmacological interventions, such as inhaled steroids, long-acting bronchodilators, and their combinations, are effective in reducing exacerbation frequency and severity 2
- Non-pharmacological therapies, such as pulmonary rehabilitation, self-management, and home ventilatory support, are also important in preventing COPD exacerbations 2
- Antibiotics, such as macrolides, may be effective in reducing exacerbation rates in some patients 6