The systemic impact of acute exacerbations of COPD requiring hospitalisation: a narrative review

Topic importance Acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) are a major cause of morbidity and mortality, with systemic effects beyond the lung complicating treatment and recovery. Understanding the multisystem impact of AECOPD, as well as established and emerging approaches to mitigate these issues, is important for optimising patient management. Review findings This review explores the systemic impact of hospitalisation with AECOPD; such as the primary pulmonary and systemic inflammatory burden, the effects of prolonged inactivity, and consequences of specific treatments. Complications include an increased risk of cardiovascular events, hyperglycaemia, cognitive impairment and confusion, and loss of muscle mass and function. These effects share several key pathophysiological features, including high-grade systemic inflammation and hypoxaemia-induced impairments to cellular energy production. Many of these systemic consequences have substantial implications for patients’ health and quality of life beyond that of the primary lung insult. As such, recognising and treating these effects are crucial in the management of AECOPD. These treatments should be specified based on the presenting features, though cornerstones include regulation of blood oxygen and glucose levels, limited use of glucocorticoids, nutritional management, and post-exacerbation pulmonary rehabilitation. Several emerging pharmacological compounds have demonstrated promise in addressing some systemic effects. Summary The systemic impact of AECOPD is widespread, with major consequences for short- and long-term outcomes. By mapping this diverse body of evidence, this narrative review highlights the need to recognise and treat systemic effects alongside the primary pulmonary insult and identifies promising avenues for novel management strategies.