**1. Introduction**

290 Chronic Obstructive Pulmonary Disease – Current Concepts and Practice

Yeo, J.; Karimova, G. & Bansal, S. (2006). Co-morbidity in older patients with COPD – Its

*Ageing*, Vol.35, No.1, (January 2006), pp. 33–37, ISSN 0002–0729

impact on health service utilisation and quality of life, a community study. *Age and* 

American Thoracic Society (ATS) and European Respiratory Society (ERS) define an exacerbation as an acute change in a patient's baseline dyspnea, cough, or sputum that is beyond normal variability, and that is sufficient to warrant a change in therapy(Celli MacNee 2004). Exacerbations have a negative impact on mortality and morbidity and as the disease progress, the frequency and severity of exacerbations increase, leading to a fall in the quality of life of COPD patients. There is no standard method or tool for the diagnosis of an exacerbation. The changes in the clinical status of the patient should be taken into account.

The most important parameters predicting mortality in patients who are hospitalized due to an acute exacerbation are; severity and stage of COPD, advanced age, co morbidities such as diabetes mellitus or cardiovascular disease, need of intubation and mechanical ventilation, high APACHE II score, presence of sepsis and multi organ failure (Groenewegen et al. 2003).
