Robert Bals
Many lung diseases have a chronic course, and this in itself can
be challenging to manage. Diseases like COPD and IPF, for
example, slowly deteriorate and treatment is often limited to
relieving symptoms. It is disastrous for the patient if the
situation gets out of control and the disease gets much worse
within a short time. It is often difficult to understand the
underlying biological processes of these deteriorations.
Exacerbations frequently result in a faster decline of the
underlying disease and can cause the death of the patient. The
field of exacerbations in pulmonary diseases is complex and
inadequately understood, for a number of reasons: 1) Generally,
the pathomechanisms of exacerbations are poorly understood. 2)
The definitions of exacerbations are often unclear, which can
cause additional difficulties in the diagnosis of these sudden
deteriorations. 3) It is often difficult to rule out relevant
differential diagnoses and in many cases, these seem to be more
than one disease entity, including infections. 4) Treatment
options can be very limited, which is largely a result of a lack of
basic understanding of what is happening.
Whilst all of this may seem pessimistic, this area actually
provides an opportunity to improve the care of our patients.
Exacerbations represent an acute-on-chronic condition and it
should be possible to focus future research on mechanisms,
diagnosis and treatment. In addition, there is clearly a need to
raise awareness about these critical conditions in pulmonary
medicine. In comparison with the number of chest pain and
stroke units, very few departments handle exacerbations of
respiratory diseases in a similar treatment structure, despite the
fact that pulmonary exacerbations have a significant impact on
the patient and on mortality figures overall.
This Monograph provides a comprehensive overview of
exacerbations in pulmonary diseases. It covers specific disease
entities such as COPD, asthma, CF and IPF, and provides detailed
information for the clinician. It also discusses the mechanisms of
exacerbation development, which is an important for the
prevention of and basic understanding about this area.
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. ix
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