Chronic obstructive pulmonary disease is a major health problem with a high prevalence, a rising incidence, and substantial morbidity and mortality. Its course is punctuated by acute episodes of increased respiratory symptoms, termed exacerbations of chronic obstructive pulmonary disease (ECOPD). ECOPD are important events in the natural history of the disease, as they are associated with lung function decline and prolonged negative effects on quality of life. The present-day therapy for ECOPD with short courses of antibiotics and steroids and escalation of bronchodilators has resulted in only modest improvements in outcomes. Recent data indicate that ECOPD are heterogeneous, raising the need to identify distinct etioendophenotypes, incorporating traits of the acute event and of patients who experience recurrent events, to develop novel and targeted therapies. These characterizations can provide a complete clinical picture, the severity of which will dictate acute pharmacological treatment, and may also indicate whether a change in maintenance therapy is needed to reduce the risk of future exacerbations. In this review we discuss the latest knowledge of ECOPD types on the basis of clinical presentation, etiology, natural history, frequency, severity, and biomarkers in an attempt to characterize these events.

中文翻译：

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慢性阻塞性肺疾病恶化的表型、病因型和内型。

慢性阻塞性肺疾病是一个主要的健康问题，其患病率高、发病率不断上升、发病率和死亡率很高。其病程中不时出现呼吸道症状加重的急性发作，称为慢性阻塞性肺疾病恶化（ECOPD）。ECOPD 是该疾病自然史中的重要事件，因为它们与肺功能下降和对生活质量的长期负面影响有关。目前治疗 ECOPD 的方法是使用短疗程的抗生素和类固醇以及逐步增加支气管扩张剂，但仅对结果产生了有限的改善。最近的数据表明，ECOPD 具有异质性，因此需要识别不同的内表型，结合急性事件和经历复发事件的患者的特征，以开发新颖的靶向疗法。这些特征可以提供完整的临床情况，其严重程度将决定急性药物治疗，也可能表明是否需要改变维持治疗以降低未来病情加重的风险。在这篇综述中，我们根据临床表现、病因、自然史、频率、严重程度和生物标志物讨论了 ECOPD 类型的最新知识，试图描述这些事件的特征。