COPD exacerbations: definitions and classifications

• Published in: The European respiratory journal Vol. 21; no. Supplement 41; pp. 46S - 53s
• Main Authors: Burge, S, Wedzicha, J.A
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Leeds Eur Respiratory Soc 01.06.2003; Maney
• Subjects: Aged; Aged, 80 and over; Airway Resistance; Biological and medical sciences; Chronic obstructive pulmonary disease, asthma; Female; Humans; Incidence; Male; Medical sciences; Middle Aged; Pneumology; Prognosis; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Gas Exchange; Recurrence; Respiratory Function Tests; Risk Assessment; Severity of Illness Index; Sputum - cytology; Total Lung Capacity; Vital Capacity; Human; Interleukin 6; Lung disease; Chronic; Prognosis; Respiratory disease; Cytokine; Bronchus disease; Severity score; Obstructive pulmonary disease; Chronic obstructive pulmonary disease aetiology definition exacerbation incidence prevention; Interleukin 8
• ISSN: 0903-1936; 0904-1850; 1399-3003
• DOI: 10.1183/09031936.03.00078002

Chronic obstructive pulmonary disease (COPD) is defined independently of exacerbations, which are largely a feature of moderate-to-severe disease. This article is the result of a workshop that tried to define exacerbations of COPD for use in clinical, pharmacological and epidemiological studies. The conclusions represent the consensus of those present. This review describes definitions, ascertainment, severity assessments, duration and frequency, using varying sources of data including direct patient interview, healthcare databases and symptom diaries kept by patients in studies. The best general definition of a COPD exacerbation is the following: an exacerbation of COPD is a sustained worsening of the patient's condition, from the stable state and beyond normal day-to-day variations that is acute in onset and may warrant additional treatment in a patient with underlying COPD. A more specific definition for studies where a bacteriological cause of exacerbation is being studied is included, as well as simpler definitions for retrospective identification from database sources. Prospective diary card assessments are best recorded as changes from an agreed baseline, rather than absolute symptom severities. Diary cards identify many unreported exacerbations, which on average have similar severities to reported exacerbations. A scale for exacerbation severity is proposed that incorporates in- and outpatient assessments. Exacerbation duration, which also relates to severity, is defined from diary card reports. Healthcare utilisation is not an adequate substitute for severity, depending on many unrelated social and comorbidity factors. It is an outcome in its own right.