**7. References**


Successful adherence-enhancing programs include simplified treatment regimens, facilitation of the physician–patient relationship and patient education methods (Petrilla &

While many studies have evaluated strategies to enhance adherence, few of these have focused on COPD. Strategies for improving adherence in COPD include simplifying treatment regimens, improving communication between providers and patients, disease education, optimising inhaler technique, reinforcement and self-management (self-

It may be important to prescribe drugs with a fixed combination and/or a low dosing frequency to enhance adherence to COPD medication. Furthermore, the recommended treatment should fit into the patient's limitations and lifestyle. Because many COPD patients are elderly, with the dual risk of cognitive impairment and complex medication regimens, the use of dosing aids and adherence devices, such as medication lists, dosette boxes and

Health-care providers must help their patients understand the progressive nature of COPD and the goals of the comprehensive treatment regimens. Physicians should actively involve patients in decisions regarding their therapy and give strong weight to their personal preferences and concerns. Periodic monitoring, understanding the patient's beliefs and positive reinforcement could also enhance adherence to therapy (Dunbar et al., 1979).

Suboptimal adherence to medication regimens and to other non-drug therapies are both major problems in the management of COPD. Poor adherence poses a significant health and economic burden in patients with COPD. Non-adherence seems to be influenced by many individual reasons, such as factors associated with the characteristics of the disease, the patient, the therapy and the physician-patient relationship. Among other things, simplified treatment regimens, adequate patient education methods and better communication between caregivers and patients have been found to be critical for overcoming the barriers of poor adherence. However, further research is needed to identify factors related to patient

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timers, should be promoted.

**6. Conclusion** 

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**15** 

Cenk Kirakli

*Turkey* 

*Izmir Dr. Suat Seren Chest Diseases and Surgery Training Hospital* 

**Management of Acute Exacerbations** 

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

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

Tracheobronchial infections (40-50% bacterial, 30-40% viral, 5-10% atypical bacteria) are involved in 50-70% of COPD exacerbations. Another factor is air pollution that is thought to be involved in 10% of exacerbations. In about 30%, the etiologic factor cannot be identified(Sapey Stockley 2006). Other medical problems, such as congestive heart failure, nonpulmonary infections, pulmonary embolism, and pneumothorax, can also lead to a

Bacterial: (Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis,

Viral: (Rhinovirus, influenza, adenovirus, parainfluenza, coronavirus, respiratory cincitial

Chlamydia pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus)

**1. Introduction** 

taken into account.

(Groenewegen et al. 2003).

COPD exacerbation.

*Environmental factors:* 

Indoor and outdoor air pollution

*Infections:* 

virus)

**2. Etiology of exacerbations** 

Yeo, J.; Karimova, G. & Bansal, S. (2006). Co-morbidity in older patients with COPD – Its impact on health service utilisation and quality of life, a community study. *Age and Ageing*, Vol.35, No.1, (January 2006), pp. 33–37, ISSN 0002–0729
