• John R Hurst, Neil Skolnik, Gerald J Hansen, Antonio Anzueto, Gavin C Donaldson, Mark T Dransfield, and Precil Varghese.
• 114 UCL Respiratory, Rayne Building, University College London, London WC1E 6JF, UK. Electronic address: j.hurst@ucl.ac.uk.
• Eur. J. Intern. Med. 2020 Mar 1; 73: 1-6.

AbstractExacerbations of chronic obstructive pulmonary disease (COPD) represent a significant clinical problem, and are associated with decreased lung function, worsening quality of life and decreased physical activity levels, with even a single exacerbation having detrimental effects. The occurrence of COPD exacerbations can also have a considerable impact on healthcare costs and mortality rates, with over one-fifth of patients hospitalized for a COPD exacerbation for the first time dying within one year of discharge. This highlights the need for COPD exacerbations to be a major focus in clinical practice. Furthermore, the substantial effect that COPD exacerbations can have on patient mental health should not be underestimated. Despite their clinical importance, COPD exacerbations are poorly recognized and reported by patients, and improving patient understanding and reporting of exacerbations to ensure prompt treatment may minimize their deleterious effects. Renewed focus on improving current clinical practice with support from evidence-based guidelines is required. This also raises a challenge to payors, healthcare systems and government policies to do more to tackle the considerable outstanding burden of COPD exacerbations.Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.

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