From Our 2010 Archives
Frequent Flare-Ups a Worse COPD Type?
Even in Milder COPD, Frequent Exacerbations May Mean Worse Disease Type
By Daniel J. DeNoon
Reviewed by Laura J. Martin, MD
Sept. 15, 2010 -- Frequent COPD flare-ups -- even in people with relatively mild disease -- may signal a worse form of the disease.
COPD stands for chronic obstructive pulmonary disease. It's a very serious, life-threatening condition that makes it difficult for a person to breathe. The disease tends to get worse over time, although COPD treatment can greatly improve quality of life and increase survival.
The hallmark feature of COPD is exacerbations -- flare-ups of severe symptoms, requiring treatment with antibiotics, steroids, and/or hospitalization. Many experts believe that each of these episodes speeds decline in lung function.
At all stages of COPD, there appear to be patients who suffer these flare-ups more often than others. To see if this is really the case, John R. Hurst, MB, ChB, PhD, of UCL Medical School, London, and colleagues conducted a three-year study of more than 2,100 COPD patients. The study was funded by drugmaker GlaxoSmithKline.
Frequent exacerbations -- two or more a year -- became more common as COPD became more severe. That wasn't particularly surprising.
But at all stages of the disease, Hurst and colleagues found, there are patients who have frequent exacerbations. Moreover, most patients who suffered frequent exacerbations at the beginning of the study continued to suffer frequent exacerbations over the next three years.
The researchers suggest that people who have frequent COPD flare-ups, even in the earlier stages of the disease, may have a worse form of COPD. Such patients, they suggest, may benefit from more aggressive treatment to prevent exacerbations.
Such treatments are available, so it's important for doctors to identify COPD patients who suffer frequent flare-ups, University of California, Los Angeles COPD expert Donald P. Tashkin, MD notes in an editorial accompanying the Hurst study in the Sept. 16 issue of the New England Journal of Medicine.
SOURCES: Hurst, J.R. New England Journal of Medicine, Sept. 16, 2010; vol 363: pp 1128-1138.Tashkin, D.P. New England Journal of Medicine, Sept. 16, 2010; vol 363: pp 1183-1184.
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