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Acute exacerbations of chronic obstructive pulmonary disease: in search of diagnostic biomarkers and treatable traits
  1. Alexander G Mathioudakis1,2,
  2. Wim Janssens3,
  3. Pradeesh Sivapalan4,
  4. Aran Singanayagam5,
  5. Mark T Dransfield6,
  6. Jens-Ulrik Stæhr Jensen4,7,8,
  7. Jørgen Vestbo1,2
  1. 1 Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
  2. 2 North West Lung Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  3. 3 Respiratory Division, Department of Clinical and Experimental Medicine, University Hospital Leuven & KU Leuven, Leuven, Belgium
  4. 4 Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
  5. 5 National Heart and Lung Institute, Imperial College London, London, UK
  6. 6 Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA
  7. 7 Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
  8. 8 PERSIMUNE&CHIP: Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
  1. Correspondence to Professor Jørgen Vestbo, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M23 9LT, UK; jorgen.vestbo{at}


Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with a significant mortality, health and economic burden. Their diagnosis, assessment and management remain suboptimal and unchanged for decades. Recent clinical and translational studies revealed that the significant heterogeneity in mechanisms and outcomes of exacerbations could be resolved by grouping them etiologically. This is anticipated to lead to a better understanding of the biological processes that underlie each type of exacerbation and to allow the introduction of precision medicine interventions that could improve outcomes. This review summarises novel data on the diagnosis, phenotyping, targeted treatment and prevention of COPD exacerbations.

  • COPD Exacerbations

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  • Contributors AGM, WJ, PS, AS and JUS contributed to the preparation of the manuscript. AGM and JV edited the manuscript for content, homogeneity and continuity. All authors contributed to critical revision of the manuscript for intellectual content.

  • Funding AGM and JV are supported by the NIHR Manchester Biomedical Research Centre (BRC).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests All authors have completed the ICMJE uniform disclosure form and declare no support by or financial relationship with any organisation that might have an interest in the submitted work in the previous 5 years. AGM reports grants from Boehringer Ingelheim, outside the submitted work. WJ reports grants from AstraZeneca, Boehringer Ingelheim and Chiesi Pharmaceuticals, outside the submitted work. PS reports personal fees from Boehringer Ingelheim and non-financial support from Novartis, outside the submitted work. AS reports personal fees from AstraZeneca, outside the submitted work. MD reports grants from the American Lung Association, NIH, Department of Veteran Affairs and the department of defence; personal fees and other support from Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, PneumRx/BTG; personal fees from Mereo and Quark Pharmaceuticals; non-financial and other support from Pulmonx; other support from Boston Scientific, Novartis, Yungjin, Gala and Nuvaira; outside the submitted work. JV reports personal fees from Chiesi Pharmaceuticals, Boehringer-Ingelheim, Novartis, AstraZeneca and GlaxoSmithKline, outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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