[Prevention of chronic obstructive pulmonary disease exacerbations]

Exacerbations of chronic obstructive pulmonary disease (COPD) aggravate disease course, induce increased morbidity and mortality, impair quality of life, and raise the direct costs of COPD. Their prevention is essential and is an integral part of the COPD program defined by French health authorities for the 2005-2010 period. Both pharmacologic and nonpharmacologic approaches have been shown to be effective in preventing exacerbations, but these treatments are still underused and misused. Important nonpharmacologic therapies that directly decrease the risk of exacerbation or hospitalization include smoking cessation, oxygen therapy, pulmonary rehabilitation, and education. Most of the drugs available for long-term management of COPD have significant effects on the frequency of exacerbations: tiotropium and salmeterol, each used alone, as well as fixed combinations of salmeterol/fluticasone or formoterol/budesonide. Tiotropium reduces the frequency of exacerbation in both moderate and severe COPD. Inhaled glucocorticosteroid agents are not recommended alone. They must be prescribed only with a long-acting bronchodilator and only to patients with severe disease and repeated exacerbations. Influenza vaccination is recommended.