Prediction and prevention of exacerbations and mortality in patients with COPD.

INTRODUCTION: Exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of the disease that have significant impact on important outcomes for patients with COPD, including disease progression and mortality. AREAS COVERED: In the present review, we summarize the risk factors and characteristics of patients with COPD who are at an increased risk for exacerbations and mortality. We will also examine currently available interventions that may lead to the effective prevention of future events. Several pharmacotherapy options have been shown to be effective in preventing exacerbations, including long-acting bronchodilators, inhaled corticosteroids and phosphodiesterase-4 inhibitors, as well as macrolides and mucolytics/antioxidants. Improvement in mortality would result from a holistic approach, combining pharmacotherapy and nonpharmacological options, as well as the appropriate management of comorbidities, which are frequent in this population. Expert Commentary: Prevention of COPD exacerbations should follow a holistic approach, including improvement in physical activity, nonpharmacological and pharmacotherapy options, and management of comorbidities. Such a comprehensive approach may result in an improvement in the overall mortality of COPD patients.