and José Luis
Chronic non-communicable respiratory diseases (e.g. asthma, COPD, CF, bronchiectasis
and IPF) are responsible for high morbidity and mortality. These diseases represent a
significant burden to patients and healthcare systems, and are considered a major challenge
in the currently ageing population worldwide. Despite their differences in nature, chronic
respiratory diseases all have one thing in common: a considerable impact on patient health
status, which mainly derives from the impact of symptoms in the short and the long term.
AEs of chronic respiratory diseases are also no longer considered to be just an increase in
symptoms. On the contrary, it has now been established that exacerbations are associated
with significant immediate risks (e.g. hospitalisation and/or death) and are responsible for a
deep long-term impact with prognostic implications.
The field of AEs in chronic respiratory diseases is challenging. Definitions of AEs differ
amongst the diseases, as investigators have used various combinations of symptoms and/or
biomarkers (e.g. imaging, lung function), which were often based on expert opinion or data
availability. Similarly, the severity of exacerbations has proven challenging to define, as
these definitions of severity often rely on therapeutic management (e.g. the need for
specific drugs and/or hospitalisation), which may have varied in different countries with
different healthcare systems. Major progress has therefore been the establishment of a
consensus for diagnosing and establishing the severity of exacerbations in each individual
disease, allowing for comparisons among studies and the development of therapeutic
strategies. In this regard, some fields have evolved rapidly (e.g. asthma and COPD), whereas
the concept of exacerbations is emerging more slowly in other diseases (e.g. CF,
bronchiectasis and IPF).
In the present issue of the ERS Monograph, we have brought together a series of articles
from internationally recognised experts in the field of exacerbations in chronic lung
diseases. The book is separated into three sections: the first section considers the definition,
severity and consequences of exacerbations in each disease. The second section looks at
exacerbation triggers, including bacterial and viral infections, air pollution and allergen
exposure; part of this section is also dedicated to the difficult problem of differential
diagnosis of exacerbations, which should not be confounded with other acute conditions
(e.g. left heart failure or pulmonary embolism). The last section discusses the treatment and
Copyright ©ERS 2017. Print ISBN: 978-1-84984-089-7. Online ISBN: 978-1-84984-090-3. Print ISSN: 2312-508X. Online ISSN: 2312-5098.
Correspondence: Pierre-Régis Burgel, APHP Pulmonary Department and Adult CF Centre, Cochin Hospital, 27 rue du Faubourg
Saint-Jacques, Paris 75014, France. E-mail:
Pulmonary Dept and Adult CF Centre, Cochin Hospital, Paris, France.
Descartes University, Sorbonne Paris Cité, Paris,
of Internal and Cardio-Respiratory Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.
Médico-Quirúrgica de Enfermedades Respiratorias, Institute de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio,
Universidad de Sevilla, Seville, Spain.
de Enfermedades Respiratorias (CIBERS), Instituto de Salud Carlos III, Madrid, Spain. xvii
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