ABSTRACT
Exacerbation of a disease implies worsening of the underlying pathophysiological
process that characterizes the condition. Indeed the term exacerbate (derived from
the Latin exacerberi, to irritate) has a dictionary definition (to make more violent,
more severe) that suggests this. However, with respect to chronic obstructive
pulmonary disease (COPD), it is not clear if we are justified in using the term
‘‘an exacerbation of COPD,’’ which implies worsening of the underlying disease or
‘‘an exacerbation in COPD,’’ which does not necessarily suggest worsening of the
underlying disease process. However, since it has been shown that the cause of an
acute exacerbation in COPD is not determined in around 30% of cases (1), this
implies that in some cases exacerbations could be part of a cyclical worsening of
the disease process itself, with or without known triggers. Indeed patients report
that their condition is better or worse on some days than others, without
obvious precipitating factors, although factors other than infection and air pollution,
which are considered to be the major precipitants, seem to exacerbate symptoms and
may lead to an exacerbation in a patient with COPD, (such as changes in weather
and temperature and changes in physical activity). However, whether an exacerba-
tion of COPD is an extension of the disease itself or is different from the disease
process is still a matter of debate. Indeed, the term exacerbation-an endogenous or
larly breathlessness, that exceeds day-to-day variations and does not respond to
treatment with the patient’s regular medication.
