10-Minute Consultation

Frequent exacerbations in chronic obstructive pulmonary disease

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d1434 (Published 4 April 2011)
Cite this as: BMJ 2011;342:d1434

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  1. Christina George, medical student1,
  2. Will Zermansky, general practitioner2,
  3. John R Hurst, clinical senior lecturer1
  1. 1Academic Unit of Respiratory Medicine, University College London Medical School, London NW3 2PF, UK
  2. 2Highgate Group Practice, London, UK
  1. Correspondence to: JR Hurst j.hurst{at}medsch.ucl.ac.uk
  • Accepted 14 February 2011

A 62 year old smoker with confirmed chronic obstructive pulmonary disease (COPD) has received his third course of steroids and antibiotics for apparent exacerbations in a year. He is anxious about the frequent flare ups and additional treatment he is being prescribed.

What you should cover

COPD is characterised by poorly reversible airflow obstruction and progressive symptoms. Exacerbation of COPD is a clinical diagnosis of exclusion and there are many causes of worsening symptoms in a patient with underlying COPD that should be considered. The frequency of exacerbations varies between patients, and the best predictor is a patient’s history of exacerbations. Patients who have frequent exacerbations have a more rapid decline in lung function, poorer quality of life, and greater mortality. Preventing exacerbations is therefore a key goal of COPD management.

Consider:

  • Are the episodes of deteriorating symptoms really exacerbations of COPD, or are there other explanations?

  • Have all available interventions to reduce exacerbations been recommended (box)?

  • Is the patient taking prescribed medication as directed?

  • Does the patient understand the impact of exacerbations and the importance of early treatment?

What you should do

Consider alternative diagnoses

Establish whether these events are truly …

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