Definition of AECOPD (Acute Exacerbation of Chronic Obstructive Pulmonary Disease)
AECOPD stands for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, which is defined as an event in the natural course of COPD characterized by a baseline change in the patient's dyspnea, cough, and/or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in regular medication. 1
Key Characteristics of AECOPD
AECOPD represents periodic escalations of symptoms including cough, dyspnea, and sputum production that contribute significantly to worsening lung function, impaired quality of life, and increased healthcare utilization 1
The American Thoracic Society emphasizes that increased dyspnea is the key symptom of an exacerbation, often accompanied by increased sputum purulence and volume, increased cough, and wheeze 2
Two-thirds of exacerbations are associated with respiratory tract infections or air pollution, while one-third present without an identifiable cause 1
Classification of AECOPD Severity
AECOPD severity is classified according to the treatment required and outcomes:
Mild: Clinical symptoms present but no change in treatment or outcome is recorded 1
Moderate: Event results in a change in medication such as the use of antibiotics and/or systemic corticosteroids 1, 2
Severe: Event leads to hospitalization or emergency room visits 1, 2
Clinical Impact of AECOPD
Exacerbations are major contributors to disease progression, with increased annual decline in lung function and poorer prognosis 3
AECOPD episodes are associated with significant mortality, especially during hospitalization or shortly thereafter 1
Patients experiencing two or more moderate-to-severe exacerbations per year are classified as "frequent exacerbators," representing a distinct subphenotype with higher mortality and accounting for more than half of COPD-related hospitalizations 4
Exacerbations dramatically reduce quality of life and consume substantial financial resources, with hospitalization due to exacerbations accounting for over 50% of the cost of managing COPD in North America and Europe 1
Diagnostic Approach to AECOPD
Chest radiography is essential to exclude differential diagnoses such as pneumonia, pneumothorax, pulmonary edema, and lung cancer 2
Arterial blood gas analysis is crucial in severe exacerbations to identify respiratory failure and assess the need for oxygen therapy or ventilatory support 2
Sputum culture and sensitivity are recommended when purulent sputum is present, previous antibiotic treatment was ineffective, or in severe exacerbations requiring hospitalization 2
Management Considerations
Pharmacologic management typically includes bronchodilators, corticosteroids, and antibiotics in most patients 5
Non-invasive positive pressure ventilation may be beneficial in hypercapnic respiratory failure to avoid endotracheal intubation 5
Early rehabilitation is recommended due to its feasibility and safety when associated with standard treatment 6
Prevention strategies include influenza vaccination, which is recommended annually to prevent acute exacerbations of COPD 1