An overview of exacerbations of chronic obstructive pulmonary disease: Can tests of small airways' function guide diagnosis and management?

Research output: Contribution to journalReview articlepeer-review


Colleges, School and Institutes

External organisations

  • University of Birmingham
  • Respiratory Therapy Department
  • King Saud bin Abdulaziz University for Health Sciences
  • University Hospital Birmingham


Chronic obstructive pulmonary disease (COPD) is common and debilitating. Most patients with COPD experience intermittent, acute deterioration in symptoms which require additional therapy, termed exacerbations. Exacerbations are prevalent in COPD and are associated with poor clinical outcomes including death, a faster decline in lung health, and a reduced quality of life. Current guidelines highlight the need to treat exacerbations promptly and then mitigate future risk. However, exacerbations are self-reported, difficult to diagnose and are treated with pharmacological therapies which have largely been unchanged over 30 years. Recent research has highlighted how exacerbations vary in their underlying cause, with specific bacteria, viruses, and cell types implicated. This variation offers the opportunity for new targeted therapies, but to develop these new therapies requires sensitive tools to reliably identify the cause, the start, and end of an exacerbation and assess the response to treatment. Currently, COPD is diagnosed and monitored using spirometric measures, principally the forced expiratory volume in 1 s and forced vital capacity, but these tests alone cannot reliably diagnose an exacerbation. Measures of small airways' function appear to be an early marker of COPD, and some studies have suggested that these tests might also provide physiological biomarkers for exacerbations. In this review, we will discuss how exacerbations of COPD are currently defined, stratified, monitored, and treated and review the current literature to determine if tests of small airways' function might improve diagnostic accuracy or the assessment of response to treatment.

Bibliographic note

Publisher Copyright: © 2020 Journal of Research in Pharmacy Practice - Published by Wolters Kluwer - Medknow. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.


Original languageEnglish
Pages (from-to)54-63
Number of pages10
JournalAnnals of Thoracic Medicine
Issue number2
Publication statusPublished - 1 Apr 2020


  • Chronic obstructive pulmonary disease, diagnosis, exacerbation, monitoring, small airway dysfunction, small airway tests