Answer 19: Remaining problems for physicians treating AECB

20 June, 2018

One key problem is the cessation of smoking in the individual COPD patient. Smoking cessation has been shown to reduce the rate of decline of FEV1 and improve survival. It also results in the cessation of coughing for 77% of patients and improvement in an additional 17% of patients. This could lead to fewer exacerbations as patients with chronic cough and sputum production have increased AECB episodes (28). However, the challenge remains to encourage patients to quit smoking.Complications from influenza infection are another concern for patients with chronic lung disease. One simple solution is annual influenza vaccinations, which reduce the morbidity and mortality from influenza in elderly patients by 50%. Vaccination also reduces hospitalization for acute and chronic respiratory conditions by as much as 39% (28). Therefore, annual influenza vaccinations are strongly recommended for patients with chronic bronchitis.Another important problem is the prolongation of the interval until the next exacerbation. This raises a lot of important questions: Are corticosteroids in this setting helpful? How can the patients avoid other risk factors beside smoking for the next exacerbation? Could we develop more potent vaccination strategies? What about potent antiviral treatment in the muculent exacerbation? These are all important considerations that require further investigation.