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Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease

Wedzicha, JA; Brill, SE; Allinson, JP; Donaldson, GC; (2013) Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease. BMC Medicine , 11 , Article 181. 10.1186/1741-7015-11-181. Green open access

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Abstract

Exacerbations of chronic obstructive pulmonary disease (COPD) are important events that carry significant consequences for patients. Some patients experience frequent exacerbations, and are now recognized as a distinct clinical subgroup, the 'frequent exacerbator' phenotype. This is relatively stable over time, occurs across disease severity, and is associated with poorer health outcomes. These patients are therefore a priority for research and treatment. The pathophysiology underlying the frequent exacerbator phenotype is complex, with increased airway and systemic inflammation, dynamic lung hyperinflation, changes in lower airway bacterial colonization and a possible increased susceptibility to viral infection. Frequent exacerbators are also at increased risk from comorbid extrapulmonary diseases including cardiovascular disease, gastroesophageal reflux, depression, osteoporosis and cognitive impairment. Overall these patients have poorer health status, accelerated forced expiratory volume over 1 s (FEV1) decline, worsened quality of life, and increased hospital admissions and mortality, contributing to increased exacerbation susceptibility and perpetuation of the frequent exacerbator phenotype. This review article sets out the definition and importance of the frequent exacerbator phenotype, with a detailed examination of its pathophysiology, impact and interaction with other comorbidities.

Type: Article
Title: Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/1741-7015-11-181
Publisher version: http://dx.doi.org/10.1186/1741-7015-11-181
Language: English
Additional information: © 2013 Wedzicha et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/1402966
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