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(Chest. 2002;121:136S-141S.)
© 2002 American College of Chest Physicians

Exacerbations*

Etiology and Pathophysiologic Mechanisms

Jadwiga A. Wedzicha, MD

* From the Academic Unit of Respiratory Medicine, St. Bartholomew’s Hospital and Royal London School of Medicine and Dentistry, Dominion House, London, UK.

Correspondence to: Jadwiga A. Wedzicha, MD, Academic Unit of Respiratory Medicine, St. Bartholomew’s Hospital and Royal London School of Medicine and Dentistry, Dominion House, West Smithfield, London EC1A 7BE, United Kingdom; e-mail: J.A.Wedzicha{at}qmul.ac.uk

Some patients with COPD are prone to frequent exacerbations, which are an important determinant of health status. Such patients have elevated airway cytokine levels, suggesting the presence of increased inflammation that may increase their susceptibility to exacerbation. The inflammatory response during a COPD exacerbation is variable, but increases in interleukin-6 levels during the exacerbation are related to the presence of a common cold. Rhinovirus infection is the most important etiologic factor in COPD exacerbations and is an important target for preventive therapy. The reduction of COPD exacerbations will have an important impact on the considerable morbidity and mortality associated with COPD.

Key Words: bacterial infection • COPD • endothelin-1 • epidemiology • exacerbations • interleukin-6 • interleukin-8 • pollution • rhinovirus • virus infection




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