Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease

• Published in: BMC medicine Vol. 11; no. 1; p. 181
• Main Authors: Wedzicha, Jadwiga A, Brill, Simon E, Allinson, James P, Donaldson, Gavin C
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.08.2013; BioMed Central
• Subjects: Bone density; Chronic obstructive pulmonary disease; Comorbidity; Complications and side effects; Development and progression; Diseases; Drug therapy; Forced Expiratory Volume - physiology; Gastroesophageal reflux; Health aspects; Humans; Lung diseases, Obstructive; Medical research; Medicine, Experimental; Patient Admission - trends; Patient outcomes; Patients; Phenotype; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - genetics; Pulmonary Disease, Chronic Obstructive - physiopathology; Quality of Life; Review; Risk factors; Severity of Illness Index; United Kingdom; Viral infections; United Kingdom
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/1741-7015-11-181

Exacerbations of chronic obstructive pulmonary disease (COPD) are important events that carry significant consequences for patients. Some patients experience frequent exacerbations, and are now recognized as a distinct clinical subgroup, the 'frequent exacerbator' phenotype. This is relatively stable over time, occurs across disease severity, and is associated with poorer health outcomes. These patients are therefore a priority for research and treatment. The pathophysiology underlying the frequent exacerbator phenotype is complex, with increased airway and systemic inflammation, dynamic lung hyperinflation, changes in lower airway bacterial colonization and a possible increased susceptibility to viral infection. Frequent exacerbators are also at increased risk from comorbid extrapulmonary diseases including cardiovascular disease, gastroesophageal reflux, depression, osteoporosis and cognitive impairment. Overall these patients have poorer health status, accelerated forced expiratory volume over 1 s (FEV1) decline, worsened quality of life, and increased hospital admissions and mortality, contributing to increased exacerbation susceptibility and perpetuation of the frequent exacerbator phenotype. This review article sets out the definition and importance of the frequent exacerbator phenotype, with a detailed examination of its pathophysiology, impact and interaction with other comorbidities.