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Semin Respir Crit Care Med 2020; 41(06): 817-829
DOI: 10.1055/s-0040-1702196
Review Article

Pneumonic versus Nonpneumonic Exacerbations of Chronic Obstructive Pulmonary Disease

Ernesto Crisafulli
1   Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
2   Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
,
Alessandra Manco
3   Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
,
Miquel Ferrer
4   Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES (CB06/06/0028), University of Barcelona, Barcelona, Spain
,
Arturo Huerta
4   Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES (CB06/06/0028), University of Barcelona, Barcelona, Spain
,
Claudio Micheletto
5   Department of Cardiovascular and Thoracic, Pneumology Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
,
Domenico Girelli
2   Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
,
Enrico Clini
6   Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy
,
Antoni Torres
4   Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES (CB06/06/0028), University of Barcelona, Barcelona, Spain
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Abstract

Patients with chronic obstructive pulmonary disease (COPD) often suffer acute exacerbations (AECOPD) and community-acquired pneumonia (CAP), named nonpneumonic and pneumonic exacerbations of COPD, respectively. Abnormal host defense mechanisms may play a role in the specificity of the systemic inflammatory response. Given the association of this aspect to some biomarkers at admission (e.g., C-reactive protein), it can be used to help to discriminate AECOPD and CAP, especially in cases with doubtful infiltrates and advanced lung impairment. Fever, sputum purulence, chills, and pleuritic pain are typical clinical features of CAP in a patient with COPD, whereas isolated dyspnea at admission has been reported to predict AECOPD. Although CAP may have a worse outcome in terms of mortality (in hospital and short term), length of hospitalization, and early readmission rates, this has only been confirmed in a few prospective studies. There is a lack of methodologically sound research confirming the impact of severe AECOPD and COPD + CAP. Here, we review studies reporting head-to-head comparisons between AECOPD and CAP + COPD in hospitalized patients. We focus on the epidemiology, risk factors, systemic inflammatory response, clinical and microbiological characteristics, outcomes, and treatment approaches. Finally, we briefly discuss some proposals on how we should orient research in the future.

Keywords

chronic obstructive pulmonary disease - acute exacerbation - community-acquired pneumonia - pneumonic - inflammatory response - outcomes

Authors’ Contributions

Drafting the work or revising it critically for important intellectual content was done by E.C., A.M., M.F., A.H., D.G., C.M., E.C. Final approval of the version submitted for publication by E.C. and A.T.




Publication History

Article published online:
29 July 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

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