Impact of exacerbations in the natural course of COPD

Exacerbations represent an important event in the natural history of patients with chronic obstructive pulmonary disease (COPD). They are associated with considerable physiological deterioration and increased airway inflammatory changes, and may enhance disease progression by accelerating the decline in lung function. Some patients are prone to frequent exacerbations, which are an important cause of hospital admission and readmission, and these frequent episodes may have considerable impact on quality of life, activities of daily living and mortality. Although exacerbations become more frequent and more severe as COPD progresses, the rate at which they occur appears to reflect an independent susceptibility phenotype: the \u201cfrequent exacerbator\u201