The role of exacerbations in the natural course of chronic obstructive pulmonary disease (COPD) is no longer disputed. The studies developed in recent years have shown that these events significantly affect quality of life, physical activity, mental state, and—how could it be otherwise?—the lung function of patients. What is new is that we agree to define a patient suffering frequent exacerbations as a carrier of a specific disease phenotype. The concept of phenotype of COPD is an idea that has emerged strongly and classifies patients according to characteristics of COPD that have clinical and prognostic significance. In this case, repeated exacerbations meet these requirements. In this issue of Hot Topics in Respiratory Medicine, recognized experts present the current knowledge about this group, subgroup, or COPD phenotype, who are characterized by having frequent exacerbations.
First, Soler-Cataluña and colleagues describe in detail the exacerbator phenotype as a patient who requires a specific treatment designed to preferentially reduce the frequency of exacerbations. Second, Wilkinson et al remind us to pay attention to the episodes reported by the patient. Not to do so can lead us to underestimate the impact of exacerbations and to overlook exacerbators who treat themselves at home without medical attention.
Finally, Dusser summarizes the evidence of clinical efficacy of the long-term anticholinergic, tiotropium, in the prevention of exacerbations. Although there is an increased inflammatory burden during exacerbations, sustained bronchodilation without the support of anti-inflammatory therapy achieved a signifi cant reduction in the incidence of exacerbations. This section also reviews the recent evidence emerging from the comparison between different types of bronchodilators in preventing exacerbations.
Recognizing patients with exacerbations should lead to more intensive treatment to prevent these episodes, which greatly alter the welfare of those who suffer from this debilatating disease.