{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:35:29Z","timestamp":1761561329532},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"1001","license":[{"start":{"date-parts":[[2009,3,1]],"date-time":"2009-03-01T00:00:00Z","timestamp":1235865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Frequent exacerbations of chronic obstructive pulmonary disease (COPD) are associated with impaired quality of life, and hospital admissions for exacerbations account for a large proportion of the expenditure of COPD. An important objective when treating COPD is to reduce the frequency of exacerbations. Studies published in the last few years have increased our knowledge on how to prevent exacerbations, but a number of questions remain unanswered. Tiotropium, inhaled steroids and long-acting inhaled \u03b2 agonists reduce the frequency of exacerbations, but further studies are necessary to determine if combining tiotropium with the other inhaled medicines is more effective than using them separately. There is evidence that mucolytics and prophylactic antibiotics reduce exacerbations, but there is uncertainty how these treatments should be used. Both influenza and pneumococcal vaccination are recommended in guidelines, although evidence for the latter remains controversial. Other interventions including oral bacterial extracts and self-management programmes warrant further study.<\/jats:p>","DOI":"10.1136\/pgmj.2008.072439","type":"journal-article","created":{"date-parts":[[2009,4,7]],"date-time":"2009-04-07T07:32:46Z","timestamp":1239089566000},"page":"141-147","source":"Crossref","is-referenced-by-count":8,"title":["Interventions to reduce the frequency of exacerbations of chronic obstructive pulmonary disease"],"prefix":"10.1093","volume":"85","author":[{"given":"P N","family":"Black","sequence":"first","affiliation":[{"name":"Department of Pharmacology and Clinical Pharmacology, University of Auckland , New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C F","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Austin Hospital , Melbourne , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2009,4,7]]},"reference":[{"key":"2023041909143692500_b1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/thx.52.2008.S1.5","article-title":"Guidelines for the management of chronic obstructive pulmonary disease","volume":"52","author":"British Thoracic Society","year":"1997","journal-title":"Thorax"},{"key":"2023041909143692500_b2","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1164\/ajrccm.157.5.9709032","article-title":"Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease","volume":"157","author":"Seemungal","year":"1998","journal-title":"Am J Respir Crit Care Med"},{"key":"2023041909143692500_b3","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1164\/ajrccm.164.3.2010017","article-title":"Lower respiratory illnesses promote FEV1 decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease","volume":"164","author":"Kanner","year":"2001","journal-title":"Am J Respir Crit Care Med"},{"key":"2023041909143692500_b4","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1164\/ajrccm.161.5.9908022","article-title":"Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease","volume":"161","author":"Seemungal","year":"2000","journal-title":"Am J Respir Crit Care Med"},{"key":"2023041909143692500_b5","article-title":"Morbidity & mortality: 2007 chart book on cardiovascular, lung and blood diseases","author":"National Heart, Lung and Blood Institute"},{"key":"2023041909143692500_b6","author":"British Thoracic Society","journal-title":"Burden of lung disease report"},{"key":"2023041909143692500_b7","doi-asserted-by":"crossref","first-page":"5S","DOI":"10.1378\/chest.117.2_suppl.5S","article-title":"The economic burden of COPD","volume":"117","author":"Sullivan","year":"2000","journal-title":"Chest"},{"key":"2023041909143692500_b8","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1513\/pats.200603-093SS","article-title":"Chronic obstructive pulmonary disease. 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