Universitat de Barcelona

Impacto & Tratamiento de las

Exacerbaciones: Estado del Arte R Rodríguez-Roisin

Never smoked or not susceptible to smoke

100

75

Susceptible smoker

50 Disability 25

predicted decline if patient stops smoking

Death 0 25

50

75

Age (years)

Fletcher C & Peto R. BMJ 1977;1:1645-8

COPD: Natural History FEV1 (% predicted at age 25 years)

FEV1 (% predicted at age 25 years)

COPD: Natural History

Agudizaciones por EPOC: Las Preguntas

100

Dyspnea Exercise Limitation

75

¿ Cómo se definen?

Exacerbations Hospitalizations

50

¿ En qué consisten?

Systemic Effects Respiratory Failure Cardiovascular Dis

25

¿ Cómo se tratan?

0 25

50

75

Age (years)

4

Agudizaciones por EPOC: Las Preguntas ¿ Cómo se definen? ¿ En qué consisten? ¿ Cómo se tratan?

COPD Exacerbations: Definition An event in the natural course of Athe sustained of thebypatient’s diseaseworsening characterized a Increased dyspnea, sputum condition, from the stable state and change in the patient’s baseline beyond normal day-to-day variations, dyspnoea, cough, and/or sputum, that volume, and sputum is that acuteisinbeyond onset and necessitates normal day-to-daya change in regular medication a patient purulence variations, is acute ininonset, and with underlying may warrant a changeCOPD in regular Anthonisen NR et al. Ann Intern Med 1987;106:196 medication in a patient with Rodrí guez-Roisin R. Chest 2000;117:398S underlying COPD (GOLD. Update’06) Rabe KF et al. AJRCCM 2007;176:532

5

1

Conditions that Aggravate and/or Mimic COPD Exacerbations

COPD Exacerbations: Consensus Definition

§ Exacerbations: Bronchial Infection (bacterial o viral) Climatic Others

§ Other Conditions: Inappropriate oxygen therapy Right-left heart failure; arrythmias Pneumonia Pulmonary embolism Pneumothorax Drugs; metabolic disorders; nutritional aspects Rodríguez-Roisin R. Chest 2000;117:398S-401S

Symptom recovery time (days)

COPD Exacerbations: Early Therapy and Recovery 24

0.42 d/d-delay (p