ABSTRACT
COPD is the fourth leading cause of death in the world and mortality rates for this
disease are increasing (1-3). In addition, acute exacerbations of COPD (AECOPD)
are common and associated with an increase in hospitalization rates and health-care
utilization and cost (1-3). Furthermore, whereas the severity of stable COPD is
associated with longer term mortality, acute exacerbations are associated with
significant short-term mortality. In hospitalized AECOPD patients, short-term or
hospital mortality has been reported to range between 4 to 26% (1-3). Primarily in
COPD, the effects of therapeutic interventions have been assessed spirometrically.
However, since pulmonary function tests do not always correlate with the patient’s
health status, there has been a switch of focus from FEV1 measurements to the
assessment of symptoms, quality of life, exertion tolerance, pharmacoeconomics,
and survival (4-7). Despite the high prevalence of the disease and the significance
of AECOPD, little is known about the ability of currently available treatments
to prevent AECOPD. This may be due to lack of a consistent and universally
accepted definition of what exactly constitutes an AECOPD and the conse-
quent lack of a consistent design in the clinical trials evaluating the results of
therapeutic interventions (3).
