In den letzten Jahren hat es einen wesentlichen Wissenszuwachs bei akuten Exazerbationen der chronisch obstruktiven Lungenerkrankung (AE-COPD) gegeben. Ihre Definition ist klarer geworden und kann in der klinischen Praxis sinnvoll eingesetzt werden. Die Rolle von Atemwegsviren als Auslöser einer AE-COPD ist zunehmend deutlicher geworden und es werden laufend noch neue Atemwegsviren identifiziert. Die Bedeutung der Bakterien ist schon länger bekannt, wobei aktuell vor allem Risikofaktoren für eine bakterielle Genese besser erkannt werden und somit die Antibiotikatherapie effizienter eingesetzt werden kann. Die antientzündliche Therapie kann aufgrund aktueller Ergebnisse sinnvoller und differenzierter eingesetzt werden und seit kurzem liegen auch Daten zu prophylaktischen Maßnahmen vor, wobei der Grippeschutzimpfung die wichtigste Rolle zukommt. Es bleibt abzuwarten, inwieweit diese neuen Erkenntnisse zu einer Verminderung der Morbidität und Mortalität der AE-COPD führen werden.
The knowledge about acute COPD exacerbations (AE-COPD) has grown tremendously within the last years. The definition of AE-COPD has become clearer and can be used expediently in clinical practice. The role of respiratory viruses as triggers of AE-COPD has become more definite and new emerging respiratory viruses are being identified. The importance of bacteria has been known for a longer time but recently clinical risk factors associated with detection of bacteria have been acknowledged allowing a more efficient use of antibiotics. The anti-inflammatory treatment can be employed more sensible and differentiated on the basis of recent data. Prophylactic measures, mainly the flu vaccination, have been shown to be important. Time will tell whether these new findings will help to reduce morbidity and mortality of AE-COPD
Key words
Acute COPD exacerbations (AE-COPD) - respiratory viruses and bacteria - antibiotics - anti-inflammatory treatment - flu vaccination
Literatur
-
1 NHLBI. .Morbidity & mortality: chartbook on cardiovascular, lung, and blood diseases. Bethesda, MD: US Department of Health and Human Services, Public Health Service, National Institutes of Health 1998;. Available from URL: www.nhlbi.nih.gov/nhlbi/seiin// other/cht-book/htm
-
2
Murray CJL, Lopez AD..
Evidence-Based Health Policy-Lessons from the Global Burden of Disease Study.
Science.
1996;
274
740-743
-
3 Weißbuch Lunge 2000: Defizite, Zukunftsperspektive, Forschungsansätze; die Lunge und Ihre Erkrankungen: zur Lage und Zukunft der Pneumologie in Deutschland. Stuttgart, New York: Georg Thieme Verlag 2000
-
4
Pauwels RA, Buist AS, Calverley PM. et al. .
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.
Am J Respir Crit Care Med.
2001;
163
1256-1276
-
5
Barnes PJ..
Chronic obstructive pulmonary disease.
N Engl J Med.
2000;
343
269-280
-
6
Anthonisen NR, Manfreda J, Warren CP. et al. .
Antibiotic therapy in acute exacerbations of chronic obstructive pulmonary disease.
Ann Intern Med.
1987;
106
196-204
-
7
Hurst JR, Donaldson GC, Wilkinson TMA. et al. .
Epidemiological relationships between the common cold and exacerbation frequency in COPD.
European Respiratory Journal.
2005;
26
846-852
-
8
Rodriguez-Roisin R..
Toward a consensus definition for COPD exacerbations.
Chest.
2000;
117
-
9
Seemungal TAR, Donaldson GC, Paul EA. et al. .
Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med.
1998;
157
1418-1422
-
10
Kanner RE, Anthonisen NR, Connett JE..
Lower Respiratory Illnesses Promote FEV1 Decline in Current Smokers But Not Ex-Smokers with Mild Chronic Obstructive Pulmonary Disease . Results from the Lung Health Study.
Am J Respir Crit Care Med.
2001;
164
358-364
-
11
Seneff MG, Wagner DP, Wagner RP. et al. .
Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease.
JAMA.
1995;
274
1852-1857
-
12
Bhowmik A, Seemungal TAR, Sapsford RJ, Wedzicha JA..
Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations.
Thorax.
2000;
55
114-120
-
13
Wedzicha JA, Seemungal TAR, McCallum PK. et al. .
Acute exacerbations of chronic obstructive pulmonary disease are accompanied by elevations of plasma fibrinogen and serum IL-6 levels.
Thromb Haemost.
2000;
84
210-215
-
14
Donaldson GC, Seemungal TAR, Bhowmik A, Wedzicha JA..
Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.
Thorax.
2002;
57
847-852
-
15
Garcia-Aymerich J, Monso E, Marrades R. et al. .
EFRAM Investigators. Risk Factors for Hospitalization for a Chronic Obstructive Pulmonary Disease Exacerbation. EFRAM STUDY.
Am J Respir Crit Care Med.
2001;
164
1002-1007
-
16
Papi A, Bellettato CM, Braccioni F. et al. .
Infections and Airway Inflammation in Chronic Obstructive Pulmonary Disease Severe Exacerbations.
Am J Respir Crit Care Med.
2006;
173
1114-1121
-
17
Sethi S..
Infectious etiology of acute exacerbations of chronic bronchitis.
Chest.
2000;
117
-
18
Smith CB, Golden CA, Kanner RE, Renzetti Ad..
Association of viral and Mycoplasma pneumoniae infections with acute respiratory illness in patients with chronic obstructive pulmonary diseases.
Am Rev Respir Dis.
19806;
121
225-232
-
19
Gump DW, Phillips CA, Forsyth BR. et al. .
Role of infection in chronic bronchitis.
Am Rev Respir Dis.
1976;
113
465-474
-
20
Buscho RO, Saxtan D, Shultz PS. et al. .
Infections with viruses and Mycoplasma pneumoniae during exacerbations of chronic bronchitis.
J Infect Dis.
1978;
137
377-383
-
21
Seemungal TAR, Harper-Owen R, Bhowmik A. et al. .
Detection of rhinovirus in induced sputum at exacerbation of chronic obstructive pulmonary disease.
Eur Respir J.
2000;
16
677-683
-
22
Seemungal T, Harper-Owen R, Bhowmik A. et al. .
Respiratory Viruses, Symptoms, and Inflammatory Markers in Acute Exacerbations and Stable Chronic Obstructive Pulmonary Disease.
Am J Respir Crit Care Med.
2001;
164
1618-1623
-
23
Rohde G, Wiethege A, Borg I. et al. .
Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalization - a case-control study.
Thorax.
2003;
58
37-42
-
24
Cameron RJ, de WD, Welsh TN, Ferguson J. et al. .
Virus infection in exacerbations of chronic obstructive pulmonary disease requiring ventilation.
Intensive Care Med.
2006;
32
1022-1029
-
25
Rohde G, Borg I, Arinir U. et al. .
Relevance of human metapneumovirus in exacerbations of COPD.
Respir Res.
2005;
6
6-150
-
26
Martinello RA, Esper F, Weibel C. et al. .
Human metapneumovirus and exacerbations of chronic obstructive pulmonary disease.
J Infect.
2006;
53
248-254
-
27
Van der HL, Pyrc K, Jebbink MF. et al. .
Identification of a new human coronavirus.
Nat Med.
2004;
10
368-373
-
28
Woo PC, Lau SK, Chu CM. et al. .
Characterization and complete genome sequence of a novel coronavirus, coronavirus HKU1, from patients with pneumonia.
J Virol.
2005;
79
-
29
Rohde G, Borg I, Arinir U. et al. .
Evaluation of a real-time polymerase-chain reaction for severe acute respiratory syndrome (SARS) associated coronavirus in patients with hospitalised exacerbation of COPD.
Eur J Med Res.
2004;
9
505-509
-
30 Allander T, Tammi MT, Eriksson M. et al. .Cloning of a human parvovirus by molecular screening of respiratory tract samples. PNAS 2005
-
31 Poole P, Chacko E, Wood-Baker R, Cates C.. Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006
-
32
Sethi S..
Bacteria in Exacerbations of Chronic Obstructive Pulmonary Disease: Phenomenon or Epiphenomenon?.
Proc Am Thorac Soc.
2004;
1
109-114
-
33
Eller J, Ede A, Schaberg T. et al. .
Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function.
Chest.
1998;
113
1542-1548
-
34
McHardy VU, Inglis JM, Calder MA. et al. .
A study of infective and other factors in exacerbations of chronic bronchitis.
Br J Dis Chest.
1980;
74
228-238
-
35
Monso E, Ruiz J, Rosell A. et al. .
Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush.
Am J Respir Crit Care Med.
1995;
152
1316-1320
-
36
Soler N, Torres A, Ewig S. et al. .
Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation.
Am J Respir Crit Care Med.
1998;
157
1498-1505
-
37
Pela R, Marchesani F, Agostinelli C. et al. .
Airways microbial flora in COPD patients in stable clinical conditions and during exacerbations: a bronchoscopic investigation.
Monaldi Arch Chest Dis.
1998;
53
262-267
-
38
Fagon JY, Chastre J, Trouillet JL. et al. .
Characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis. Use of the protected specimen brush technique in 54 mechanically ventilated patients.
Am Rev Respir Dis.
1990;
142
1004-1008
-
39
Sethi S, Evans N, Grant BJB, Murphy TF..
New Strains of Bacteria and Exacerbations of Chronic Obstructive Pulmonary Disease.
N Engl J Med.
2002;
347
465-471
-
40
Stockley RA, O'Brien C, Pye A, Hill SL..
Relationship of sputum colour to nature and outpatient management of acute exacerbations of COPD.
Chest.
2000;
117
1638-1645
-
41
Soler N, Agusti C, Angrill J. et al. .
Bronchoscopic validation of the significance of sputum purulence in severe exacerbations of chronic obstructive pulmonary disease.
Thorax.
2007;
62
29-35
-
42
Nseir S, Di PC, Cavestri B. et al. .
Multiple-drug-resistant bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease: Prevalence, risk factors, and outcome.
Crit Care Med.
2006;
34
2959-2966
-
43
Diederen BM, van V d., Kluytmans JA, Peeters MF, Hendrix R..
The role of atypical respiratory pathogens in exacerbations of chronic obstructive pulmonary disease.
Eur Respir J.
2007;
30
240-244
-
44
Vogelmeier C, Buhl R, Criee CP. et al. .
Guidelines for the diagnosis and therapy of COPD issued by Deutsche Atemwegsliga and Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin.
Pneumologie.
2007;
61
1-40
-
45
Powrie DJ, Wilkinson TM, Donaldson GC. et al. .
Effect of tiotropium on sputum and serum inflammatory markers and exacerbations in chronic obstructive pulmonary disease.
Eur Respir.
2007;
15
-
46
Stockley RA, Whitehead PJ, Williams MK..
Improved outcomes in patients with chronic obstructive pulmonary disease treated with salmeterol compared with placebo/usual therapy: results of a meta-analysis.
Respir Res.
2006;
7
147
-
47
Kardos P, Wencker M, Glaab T, Vogelmeier C..
Impact of Salmeterol/Fluticasone Propionate versus Salmeterol on Exacerbations in Severe Chronic Obstructive Pulmonary Disease.
Am J Respir Crit Care Med.
2007;
175
144-149
-
48
de Jong YP, Uil SM, Grotjohan HP. et al. .
Oral or Intravenous Prednisolone in the Treatment of COPD Exacerbations: a randomized controlled, double blind study.
Chest.
2007;
23
-
49
Gunen H, Hacievliyagil SS, Yetkin O. et al. .
The role of nebulised budesonide in the treatment of exacerbations of COPD.
Eur Respir J.
2007;
29
660-667
-
50
Zuin R, Palamidese A, Negrin R. et al. .
High-dose N-acetylcysteine in patients with exacerbations of chronic obstructive pulmonary disease.
Clin Drug Investig.
2004;
25
401-408
-
51
Sutherland ER, Crapo JD, Bowler RP..
N-acetylcysteine and exacerbations of chronic obstructive pulmonary disease.
COPD.
2006;
3
195-202
-
52
Poole P, Black P..
Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease.
Cochrane Database Syst Rev.
2006;
3
-
53
Ram FS, Rodriguez-Roisin R, Granados-Navarrete A. et al. .
Antibiotics for exacerbations of chronic obstructive pulmonary disease.
Cochrane Database Syst Rev.
2006;
2
-
54
Hoffken G, Lorenz J, Kern W. et al. .
S3-guideline on ambulant acquired pneumonia and deep airway infections.
Pneumologie.
2005;
59
612-664
-
55
Lode H, Allewelt M, Balk S. et al. .
A Prediction Model for Bacterial Etiology in Acute Exacerbations of COPD.
Infection.
2007;
35
143-149
-
56 Canut A, Martin-Herrero JE, Labora A, Maortua H.. What are the most appropriate antibiotics for the treatment of acute exacerbation of chronic obstructive pulmonary disease? A therapeutic outcomes model. J Antimicrob Chemother 2007
-
57
Bustamante-Fermosel A, De Miguel-Yanes JM, Duffort-Falco M, Munoz J..
Mortality-related factors after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: the burden of clinical features.
Am J Emerg Med.
2007;
25
515-522
-
58
Niewoehner DE, Lokhnygina Y, Rice K. et al. .
Risk Indexes for Exacerbations and Hospitalizations Due to COPD.
Chest.
2007;
131
20-28
-
59
Tsai CL, Clark S, Cydulka RK. et al. .
Factors associated with hospital admission among emergency department patients with chronic obstructive pulmonary disease exacerbation.
Acad Emerg Med.
2007;
14
6-14
-
60
Sprenkle MD, Niewoehner DE, MacDonald R. et al. .
Clinical efficacy of OM-85 BV in COPD and chronic bronchitis: a systematic review.
COPD.
2005;
2
167-175
Korrespondenz
Prof. Dr. med. Gernot Rohde
Medizinische Klinik III Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH
Bürkle-de-la-Camp-Platz 1
44789 Bochum
Fax: 0234/302-6420
Email: gernot.rohde@rub.de
