ABSTRACT
Exacerbation of chronic obstructive pulmonary disease (COPD) is usually defined as an acute episode of sustained deterioration of symptoms, i.e., worsening of dyspnea and change in sputum, beyond normal day-to-day variations (1). Although many exacerbations are successfully managed in primary care, they are yet a common cause of hospital admission, often after failed initial therapy in the community. Exacerbations are severely distressing events that impact greatly on health status, loss of symptom control, and activities of daily live. Frequent exacerbations significantly diminish patients’ health status (2), and moderate to severe COPD patients have a mean of two exacerbations a year (3). Patients’ symptom recovery time varies between 4 and 14 days (3,4) except that activities of daily living and mental state can take longer to recover, up to 18 and 39 days (4). Decreasing the rate of exacerbations is associated with improved quality of life (5,6) and thus would be expected to reduce hospitalizations and benefit health care costs (7). Furthermore, early report and treatment have been shown to reduce the length of an exacerbation, to improve patients’ health status, and to decrease hospital admissions (8).
