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Exacerbations in Chronic Obstructive Pulmonary Disease

Do They Contribute to Disease Progression?

¹ Channing Laboratory and Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachussetts

Correspondence and requests for reprints should be addressed to Edwin K. Silverman, M.D., Ph.D., Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115. E-mail: ed.silverman{at}channing.harvard.edu

ABSTRACT

The impact of chronic obstructive pulmonary disease (COPD) exacerbations on decline in FEV₁ has been a controversial topic for decades. We will review some of the key studies in this area and discuss potential contributors to inconsistent results of these studies. Dissecting the heterogeneous COPD syndrome into meaningful subtypes and assessing the genetic and environmental influences on COPD-related phenotypes such as exacerbation frequency could clarify the impact of exacerbations on the natural history of COPD.

Key Words: chronic obstructive pulmonary disease • exacerbations • natural history • heterogeneity • genetics