ReviewThorax2019
Building toolkits for COPD exacerbations: lessons from the past and present.
Review in Thorax, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it.
- AAmerican journal of respiratory and critical care medicine · 2022Pooled it
- Comparing Pneumonia Risks of Budesonide with Fluticasone Among Patients with Asthma in Hong Kong: A Territory-Wide Retrospective Study.Advances in therapy · 2026Article
- Epithelial cells in chronic obstructive pulmonary disease exacerbations: Targets for lung repair.Pharmacological reviews · 2026Review
- Differences in survival between two cohorts of COPD patients living in Mexico City: a 20-year cohort comparison.Respiratory research & clinical practice · 2026Article
- Observational
- Phenotypes of Exacerbations in Chronic Obstructive Pulmonary Disease.Journal of clinical medicine · 2025Review
- Aspergillus fumigatus is responsible for inflammation in a murine model of chronic obstructive pulmonary disease exacerbation.Respiratory research · 2025Article
- Does adherence to exacerbation action plans matter? Insights from two COPD self-management studies.Heliyon · 2024Article
- Rational use of inhaled corticosteroids for the treatment of COPD.NPJ primary care respiratory medicine · 2023Review
- Early detection and prediction of acute exacerbation of chronic obstructive pulmonary disease.Chinese medical journal pulmonary and critical care medicine · 2023Review
- Twenty years of changes in the definition of early chronic obstructive pulmonary disease.Chinese medical journal pulmonary and critical care medicine · 2023Review
- Increased Red Blood Cell Distribution Predicts Severity of Chronic Obstructive Pulmonary Disease Exacerbation.Journal of personalized medicine · 2023Article
- Exploring Patterns of COPD Exacerbations and Comorbid Flare-Ups.International journal of chronic obstructive pulmonary disease · 2023Article
- MRI-assessed diaphragmatic function can predict frequent acute exacerbation of COPD: a prospective observational study based on telehealth-based monitoring system.BMC pulmonary medicine · 2022Observational
- Clinical Efficacy of Carbocysteine in COPD: Beyond the Mucolytic Action.Pharmaceutics · 2022Review
- Carbocysteine Modifies Circulating miR-21, IL-8, sRAGE, and fAGEs Levels in Mild Acute Exacerbated COPD Patients: A Pilot Study.Pharmaceuticals (Basel, Switzerland) · 2022Article
- IgE is associated with exacerbations and lung function decline in COPD.Respiratory research · 2022Article
- Towards precision in defining COPD exacerbations.Breathe (Sheffield, England) · 2021Review
- Article
- The Role of Extracellular Vesicles as a Shared Disease Mechanism Contributing to Multimorbidity in Patients With COPD.Frontiers in immunology · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
In the nineteenth century, it was recognised that acute attacks of chronic bronchitis were harmful. 140 years later, it is clearer than ever that exacerbations of chronic obstructive pulmonary disease (ECOPD) are important events. They are associated with significant mortality, morbidity, a reduced quality of life and an increasing reliance on social care. ECOPD are common and are increasing in prevalence. Exacerbations beget exacerbations, with up to a quarter of in-patient episodes ending with readmission to hospital within 30 days. The healthcare costs are immense. Yet despite this, the tools available to diagnose and treat ECOPD are essentially unchanged, with the last new intervention (non-invasive ventilation) introduced over 25 years ago.An ECOPD is 'an acute worsening of respiratory symptoms that results in additional therapy'. This symptom and healthcare utility-based definition does not describe pathology and is unable to differentiate from other causes of an acute deterioration in breathlessness with or without a cough and sputum. There is limited understanding of the host immune response during an acute event and no reliable and readily available means to identify aetiology or direct treatment at the point of care (POC). Corticosteroids, short acting bronchodilators with or without antibiotics have been the mainstay of treatment for over 30 years. This is in stark contrast to many other acute presentations of chronic illness, where specific biomarkers and mechanistic understanding has revolutionised care pathways. So why has progress been so slow in ECOPD? This review examines the history of diagnosing and treating ECOPD. It suggests that to move forward, there needs to be an acceptance that not all exacerbations are alike (just as not all COPD is alike) and that clinical presentation alone cannot identify aetiology or stratify treatment.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.