Extra-Pulmonary Aspects of Exacerbations of Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a systemic disease with multiple comorbidities and organ disorders, punctuated by exacerbations. Inflammation, hypoxemia, coagulation disorders and disturbances of the heart-lung interactions explain in part the non-pulmonary disorders observed especially during acute exacerbations. Cardiovascular events are the leading cause of death in COPD patients, and their recrudescence is observed for several weeks after an exacerbation. The management of these patients in emergency departments consists therefore, in addition to the ventilatory support, in a good evaluation of concomitant heart failure, myocardial ischemic signs, renal failure, or thromboembolic disease. This global evaluation makes it possible to adapt the sometimes deleterious therapies on the cardiac function or the acid-base balance, and to take into account the extra-pulmonary risk in the choice of the patient's care pathway. In this review, we discuss physiological explanations of the multiple disturbances observed during the exacerbation of COPD, and provide a global vision of what should be included in any evaluation of these patients admitted for dyspnea or any other reason that may be related to COPD.