• Asthma
• chronic obstructive lung disease
• exacerbations
• systems approach and lung attacks
• COPD exacerbations

Acute exacerbations of asthma and chronic obstructive lung disease (COPD) are significant burdens on the health care system.1 2 The economic burden is particularly high with both types of exacerbations. Unfortunately the management of these common occurrences is often haphazard and fragmented. The gaps in care relate both to the management of the specific episode in question3 and to the risk stratification of patients subsequent to the event.4 This lack of current and ongoing optimal care is disappointing, especially given the documented poor prognostic factors associated with these events. Patients hospitalised with acute asthma, and especially episodes of near fatal asthma, are associated with significantly increased future risks of intubation.5 In the case of COPD the outcomes are even more dramatic; in-hospital mortality for an acute exacerbation of COPD is at least 10% and 1-year mortality, posthospitalisation, approaches 25%. In addition to these immediate increased risks associated with exacerbations there is also a significant decline in lung function associated with both types of exacerbations.6 7 Given these data, the response of the health care system to these events is disappointing.7 This response is quite different from what occurs with a ‘heart attack’. In the case of an acute myocardial infarction initial management is much more aggressive, risk stratification is routine and patients are usually discharged on a medication bundle. In addition standard of care involves patients being enrolled in well-funded cardiac rehabilitation programmes. Similar comparisons have been drawn with the previously used term of a stroke which has in many settings been replaced with the term ‘brain attack’.

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