Action plans to reduce hospitalizations for chronic obstructive pulmonary disease exacerbations: focus on oral corticosteroids

PATHOLOGIC PHYSIOLOGY OF EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The lecture describes the mechanisms of deterioration of respiratory exchange during exacerbation of chronic obstructive pulmonary disease (COPD). It has been demonstrated that the rapid diagnosis and treatment of exacerbations is an important part of COPD management. The restriction of expiratory airflow followed by the increased dynamic pulmonary hyperinflation seems to be the most important pathophysiological mechanism in COPD exacerbation, which has catastrophic consequences for the respiratory system with respect to respiratory mechanics and gas exchange. In some patients, associated disorders of cardiopulmonary interactions also undoubtedly play an important role.

Action plans for COPD: strategies to manage exacerbations and improve outcomes

COPD is the third-largest killer in the world, and certainly takes a toll on the health care system. Recurrent COPD exacerbations accelerate lung-function decline, worsen mortality, and consume over US$50 billion in health care spending annually. This has led to a tide of payment reforms eliciting interest in strategies reducing preventable COPD exacerbations. In this review, we analyze and discuss the evidence for COPD action plan-based self-management strategies. Although action plans may provide stabilization of acute symptomatology, there are several limitations. These include patient-centered attributes, such as comprehension and adherence, and nonadherence of health care providers to established guidelines. While no single intervention can be expected independently to translate into improved outcomes, structured together within a comprehensive integrated disease-management program, they may provide a robust paradigm.