Chest
Volume 117, Issue 5, Supplement 2, May 2000, Pages 398S-401S
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Toward a Consensus Definition for COPD Exacerbations

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In patients with COPD, an acute worsening of respiratory symptoms is often described as an exacerbation. Exacerbations are associated with a significant increase in mortality, hospitalization, and health-care utilization, but there is currently no widely accepted definition of what constitutes an exacerbation of COPD. This paper summarizes the discussions of the workshop, “COPD: Working Towards a Greater Understanding,” in which the participants proposed the following working definition of an exacerbation of COPD: 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 necessitates a change in regular medication in a patient with underlying COPD.

Section snippets

The Need for a Standardized Definition of COPD Exacerbations

While there is currently no general agreement on the definition for a COPD exacerbation, a standardized definition could provide benefits to patients, researchers, physicians, and other health-care providers.

For example, a standard definition will help patients to determine when they should approach their primary-care physician or visit the emergency department, and it will guide physicians with respect to appropriate pharmacotherapy and/or other interventions. An agreed definition will help in

Working Group Definition

The objective of the workshop was to reach a common definition for COPD exacerbations that would initiate a dialogue between interested parties, and ultimately lead to a globally accepted consensus definition. The definition reached by the group was as follows: 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 necessitates a change in regular medication in a patient with underlying COPD. The rationale

Staging COPD Exacerbations

Owing to the generalized nature of the definition presented above, some type of subclassification will be necessary to improve its practical utility. The most obvious staging system might relate to the severity of the exacerbation, and Table 2 shows a proposed system based on the utilization of health-care resources by patients with mild, moderate, or severe exacerbations. However, the ultimate purpose of the definition will influence those parameters considered most appropriate on which to

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