{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T23:31:49Z","timestamp":1785367909146,"version":"3.55.0"},"reference-count":119,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T00:00:00Z","timestamp":1683590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality worldwide. Hospitalization due to acute exacerbations of COPD (AECOPD) is a relevant health problem both for its impact on disease outcomes and on health system resources. Severe AECOPD causing acute respiratory failure (ARF) often requires admission to an intensive care unit (ICU) with endotracheal intubation and invasive mechanical ventilation. AECOPD also acts as comorbidity in critically ill patients; this condition is associated with poorer prognoses. The prevalence reported in the literature on ICU admission rates ranges from 2 to 19% for AECOPD requiring hospitalization, with an in-hospital mortality rate of 20\u201340% and a re-hospitalization rate for a new severe event being 18% of the AECOPD cases admitted to ICUs. The prevalence of AECOPD in ICUs is not properly known due to an underestimation of COPD diagnoses and COPD misclassifications in administrative data. Non-invasive ventilation in acute and chronic respiratory failure may prevent AECOPD, reducing ICU admissions and disease mortality, especially when associated with a life-threating episode of hypercapnic ARF. In this review, we report on up to date evidence from the literature, showing how improving the knowledge and management of AECOPD is still a current research issue and clinical need.<\/jats:p>","DOI":"10.3390\/jcm12103369","type":"journal-article","created":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T01:57:51Z","timestamp":1683683871000},"page":"3369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["COPD Exacerbation: Why It Is Important to Avoid ICU Admission"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2709-919X","authenticated-orcid":false,"given":"Irene","family":"Prediletto","sequence":"first","affiliation":[{"name":"Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Science (DIMEC), Via Massarenti 9, 40138 Bologna, Italy"},{"name":"IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit, Policlinico S. Orsola-Malpighi di Bologna, Via Albertoni 15, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6326-069X","authenticated-orcid":false,"given":"Gilda","family":"Giancotti","sequence":"additional","affiliation":[{"name":"Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Science (DIMEC), Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8404-2085","authenticated-orcid":false,"given":"Stefano","family":"Nava","sequence":"additional","affiliation":[{"name":"Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Science (DIMEC), Via Massarenti 9, 40138 Bologna, Italy"},{"name":"IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit, Policlinico S. Orsola-Malpighi di Bologna, Via Albertoni 15, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"020415","DOI":"10.7189\/jogh.05.020415","article-title":"Global and regional estimates of COPD prevalence: Systematic review and meta-analysis","volume":"5","author":"Adeloye","year":"2015","journal-title":"J. Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1080\/15412555.2022.2136065","article-title":"Short- and Long-Term Impact of Prior Chronic Obstructive Pulmonary Disease Exacerbations on Healthcare Resource Utilization and Related Costs: An Observational Study (SHERLOCK)","volume":"20","author":"Haughney","year":"2023","journal-title":"COPD J. Chronic Obstr. Pulm. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1164\/rccm.202209-1795CI","article-title":"Differential Diagnosis of Suspected COPD Exacerbations in the Acute Care Setting: Best Practice","volume":"207","author":"Celli","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_4","unstructured":"World Health Organization (2023, March 16). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/chronic-obstructive-pulmonary-disease-(copd)."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1900164","DOI":"10.1183\/13993003.00164-2019","article-title":"Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: The GOLD science committee report 2019","volume":"53","author":"Singh","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1513\/pats.200707-088ET","article-title":"Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease","volume":"5","author":"MacIntyre","year":"2008","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1378\/chest.06-1610","article-title":"Impact of COPD exacerbations on patient-centered outcomes","volume":"131","author":"Cote","year":"2007","journal-title":"Chest"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1055\/s-0034-1383864","article-title":"Noninvasive ventilation in acute hypercapnic respiratory failure","volume":"35","author":"Pisani","year":"2014","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s40248-018-0149-0","article-title":"Management of severe acute exacerbations of COPD: An updated narrative review","volume":"13","author":"Crisafulli","year":"2018","journal-title":"Multidiscip. Respir. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1183\/09031936.06.00139305","article-title":"Implications of COPD in patients admitted to the intensive care unit by community-acquired pneumonia","volume":"27","author":"Rello","year":"2006","journal-title":"Eur. Respir. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.rmed.2011.03.001","article-title":"The impact of COPD on ICU mortality in patients with ventilator-associated pneumonia","volume":"105","author":"Makris","year":"2011","journal-title":"Respir. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1183\/09031936.00226411","article-title":"Prevalence and prognosis of COPD in critically ill patients between 1998 and 2008","volume":"41","author":"Funk","year":"2013","journal-title":"Eur. Respir. J."},{"key":"ref_13","first-page":"e988","article-title":"Relationship between Severity Classification of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Clinical Outcomes in Hospitalized Patients","volume":"9","author":"Marcos","year":"2017","journal-title":"Cureus"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Pozo-Rodriguez, F., Lopez-Campos, J.L., Alvarez-Mart\u00ednez, C.J., Castro-Acosta, A., Ag\u00fcero, R., Hueto, J., Hern\u00e1ndez-Hern\u00e1ndez, J., Barr\u00f3n, M., Abraira, V., and Forte, A. (2012). Clinical audit of COPD patients requiring hospital admissions in Spain: AUDIPOC study. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0042156"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.arbres.2014.06.023","article-title":"Clinical audit of patients hospitalized due to COPD exacerbation. MAG-1 Study","volume":"51","author":"Escarrabill","year":"2015","journal-title":"Arch. Bronconeumol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"439","DOI":"10.2147\/COPD.S234942","article-title":"Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review","volume":"15","author":"Iheanacho","year":"2020","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1590\/S1806-37132011000300009","article-title":"Patients admitted to the ICU for acute exacerbation of COPD: Two-year mortality and functional status","volume":"37","author":"Teixeira","year":"2011","journal-title":"J. Bras. Pneumol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1378\/chest.128.2.518","article-title":"In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: A retrospective study","volume":"128","author":"Lee","year":"2005","journal-title":"Chest"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e0487","DOI":"10.1097\/MD.0000000000010487","article-title":"Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD)","volume":"97","author":"Gadre","year":"2018","journal-title":"Medicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1136\/bmj.332.7550.1142","article-title":"ABC of chronic obstructive pulmonary disease. Definition, epidemiology, and risk factors","volume":"332","author":"Devereux","year":"2006","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Gothe, H., Rajsic, S., Vukicevic, D., Schoenfelder, T., Jahn, B., Geiger-Gritsch, S., Brixner, D., Popper, N., Endel, G., and Siebert, U. (2019). Algorithms to identify COPD in health systems with and without access to ICD coding: A systematic review. BMC Health Serv. Res., 19.","DOI":"10.1186\/s12913-019-4574-3"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e0149302","DOI":"10.1371\/journal.pone.0149302","article-title":"How Reliable Are Current Data for Assessing the Actual Prevalence of Chronic Obstructive Pulmonary Disease?","volume":"11","author":"Romanelli","year":"2016","journal-title":"PLoS ONE"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"757","DOI":"10.2147\/COPD.S36997","article-title":"Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population","volume":"7","author":"Pasquale","year":"2012","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1136\/thoraxjnl-2011-201518","article-title":"Long-term natural history of chronic obstructive pulmonary disease: Severe exacerbations and mortality","volume":"67","author":"Suissa","year":"2012","journal-title":"Thorax"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1164\/ajrccm.154.4.8887592","article-title":"Outcomes of acute exacerbations of severe chronic obstructive lung disease","volume":"154","author":"Connors","year":"1996","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1097\/00003246-200207000-00035","article-title":"Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure","volume":"30","author":"Afessa","year":"2002","journal-title":"Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1513\/AnnalsATS.201911-821OC","article-title":"Characteristics and Outcomes of Critically Ill Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Australia and New Zealand","volume":"17","author":"Berenyi","year":"2020","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"107090","DOI":"10.1016\/j.rmed.2022.107090","article-title":"Readmission rate fo acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis","volume":"206","author":"Ruan","year":"2023","journal-title":"Respir. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3","DOI":"10.12746\/swrccc2013.0102.013","article-title":"Factors affecting mortality in patients with COPD exacerbations requiring ICU admission","volume":"1","author":"Limsuwat","year":"2013","journal-title":"Southwest. Respir. Crit. Care Chron."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12931-021-01657-4","article-title":"Predictors of mortality in COPD exacerbation cases presenting to the respiratory intensive care unit","volume":"22","author":"Cao","year":"2021","journal-title":"Respir. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2153644","DOI":"10.1080\/20018525.2022.2153644","article-title":"Hypoxemia and not hyperoxemia predicts worse outcome in severe COPD exacerbations\u2014An observational study","volume":"10","author":"Sandau","year":"2022","journal-title":"Eur. Clin. Respir. J."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Chen, P.K., Hsiao, Y.H., Pan, S.W., Su, K.C., Perng, D.W., and Ko, H.K. (2019). Independent factors associate with hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease requiring intensive care unit admission: Focusing on the eosinophil-to-neutrophil ratio. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0218932"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"49","DOI":"10.4266\/acc.2022.01011","article-title":"Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure","volume":"38","year":"2023","journal-title":"Acute Crit. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1097\/CCM.0b013e318170a405","article-title":"Determinants of long-term survival after intensive care","volume":"36","author":"Williams","year":"2008","journal-title":"Crit. Care Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1136\/thorax.57.1.29","article-title":"Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: A long term follow up study","volume":"57","author":"Breen","year":"2002","journal-title":"Thorax"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1017\/S0265021508004225","article-title":"Arterial blood gas derangement and level of comorbidity are not predictors of long-term mortality of COPD patients treated with mechanical ventilation","volume":"25","author":"Christensen","year":"2008","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1136\/thx.2004.024307","article-title":"Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure","volume":"59","author":"Chu","year":"2004","journal-title":"Thorax"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1097\/01.CCM.0000108879.86838.4F","article-title":"Noninvasive ventilation in patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease who refused endotracheal intubation","volume":"32","author":"Chu","year":"2004","journal-title":"Crit. Care Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4103\/0019-5049.126785","article-title":"Health-care-associated infections: Risk factors and epidemiology from an intensive care unit in Northern India","volume":"58","author":"Datta","year":"2014","journal-title":"Indian J. Anaesth."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1080\/15412555.2016.1254173","article-title":"Changes of Respiratory Mechanics in COPD Patients from Stable State to Acute Exacerbations with Respiratory Failure","volume":"14","author":"Ceriana","year":"2017","journal-title":"COPD J. Chronic Obstr. Pulm. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1056\/NEJMoa0909883","article-title":"Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators. Susceptibility to exacerbation in chronic obstructive pulmonary disease","volume":"363","author":"Hurst","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1183\/09031936.00195608","article-title":"Efficacy of moxifloxacin in the treatment of bronchial colonisation in COPD","volume":"34","author":"Miravitlles","year":"2009","journal-title":"Eur. Respir. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1111\/ijcp.12248","article-title":"Chronic bronchitis in COPD patients is associated with increased risk of exacerbations: A cross-sectional multicentre study","volume":"67","author":"Corhay","year":"2013","journal-title":"Int. J. Clin. Pract."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1159\/000067462","article-title":"Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: A multiple logistic regression analysis. The EOLO Study Group","volume":"67","author":"Miravitlles","year":"2000","journal-title":"Respiration"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Ringshausen, F.C., de Roux, A., Pletz, M.W., H\u00e4m\u00e4l\u00e4inen, N., Welte, T., and Rademacher, J. (2013). Bronchiectasis-associated hospitalizations in Germany, 2005\u20132011: A population-based study of disease burden and trends. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0071109"},{"key":"ref_46","first-page":"253","article-title":"Association of gastroesophageal reflux disease symptoms with exacerbations of chronic obstructive pulmonary disease","volume":"19","author":"Rogha","year":"2010","journal-title":"J. Gastrointestin. Liver Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1378\/chest.130.4.1096","article-title":"Role of gastroesophageal reflux symptoms in exacerbations of COPD","volume":"130","author":"Pamer","year":"2006","journal-title":"Chest"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/resp.12420","article-title":"Gastro-esophageal reflux disease and exacerbations in chronic obstructive pulmonary disease","volume":"20","author":"Ingebrigtsen","year":"2015","journal-title":"Respirology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1136\/thx.2007.092858","article-title":"Impact of gastro-oesophageal reflux disease symptoms on COPD exacerbation","volume":"63","author":"Terada","year":"2008","journal-title":"Thorax"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1164\/rccm.200305-648OC","article-title":"Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease","volume":"170","author":"Patel","year":"2004","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"43S","DOI":"10.1378\/chest.108.2_Supplement.43S","article-title":"Epidemiology and treatment of chronic bronchitis and its exacerbations","volume":"108","author":"Ball","year":"1995","journal-title":"Chest"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s40200-021-00766-7","article-title":"Characteristics and outcomes of diabetic patients with acute exacerbation of COPD","volume":"20","author":"Monsour","year":"2021","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1378\/chest.13-0488","article-title":"Pneumonic and nonpneumonic exacerbations of COPD: Inflammatory response and clinical characteristics","volume":"144","author":"Huerta","year":"2013","journal-title":"Chest"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1183\/09031936.00041914","article-title":"Viral, bacterial or both? Regardless, we need to treat infection in COPD","volume":"44","author":"Welte","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2355","DOI":"10.1056\/NEJMra0800353","article-title":"Infection in the pathogenesis and course of chronic obstructive pulmonary disease","volume":"359","author":"Sethi","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"293","DOI":"10.3389\/fmicb.2013.00293","article-title":"Virus-induced exacerbations in asthma and COPD","volume":"4","author":"Kurai","year":"2013","journal-title":"Front. Microbiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1056\/NEJMoa012561","article-title":"New strains of bacteria and exacerbations of chronic obstructive pulmonary disease","volume":"347","author":"Sethi","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"00282-2019","DOI":"10.1183\/23120541.00282-2019","article-title":"Pneumonia in exacerbations of COPD: What is the clinical significance?","volume":"6","author":"Trethewey","year":"2020","journal-title":"ERJ Open Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1111\/irv.13050","article-title":"Serious Outcomes Surveillance and Canadian Immunization Research Network (CIRN) Investigators. Impact of respiratory viral infections on mortality and critical illness among hospitalized patients with chronic obstructive pulmonary disease","volume":"16","author":"Mulpuru","year":"2022","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1183\/09031936.00223113","article-title":"Human rhinovirus infection during naturally occurring COPD exacerbations","volume":"44","author":"George","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.2147\/COPD.S378034","article-title":"The Influence of Influenza Virus Infections in Patients with Chronic Obstructive Pulmonary Disease","volume":"17","author":"Liao","year":"2022","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12950-022-00305-y","article-title":"Influenza a virus triggers acute exacerbation of chronic obstructive pulmonary disease by increasing proinflammatory cytokines secretion via NLRP3 inflammasome activation","volume":"19","author":"Ji","year":"2022","journal-title":"J. Inflamm."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.4187\/respcare.06661","article-title":"Incidence and Impact of Pulmonary Embolism During Severe COPD Exacerbation","volume":"64","author":"Hassen","year":"2019","journal-title":"Respir. Care"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.2147\/COPD.S192047","article-title":"Effects of air pollution on acute exacerbation of chronic obstructive pulmonary disease: A descriptive retrospective study (pol-AECOPD)","volume":"14","year":"2019","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s11869-023-01310-7","article-title":"Environmental pollution in North-Eastern Italy and its influence on chronic obstructive pulmonary disease: Time series modelling and analysis using visibility graphs","volume":"16","year":"2023","journal-title":"Air Qual. Atmos. Health"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"46435","DOI":"10.1007\/s11356-023-25567-8","article-title":"Associations between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Jinan: Potential benefits from air quality improvements","volume":"30","author":"Cheng","year":"2023","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_67","first-page":"260","article-title":"Air pollution and chronic obstructive pulmonary disease","volume":"6","author":"Duan","year":"2020","journal-title":"Chronic Dis. Transl. Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/S0140-6736(09)60496-7","article-title":"Non-invasive ventilation in acute respiratory failure","volume":"374","author":"Nava","year":"2009","journal-title":"Lancet"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.ccell.2012.06.001","article-title":"Management of COPD patients in the intensive care unit","volume":"24","author":"McCauley","year":"2012","journal-title":"Crit. Care Nurs. Clin. N. Am."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e006720","DOI":"10.1136\/bmjopen-2014-006720","article-title":"The impact of exacerbation frequency on mortality following acute exacerbations of COPD: A registry-based cohort study","volume":"4","author":"Schmidt","year":"2014","journal-title":"BMJ Open"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e0150737","DOI":"10.1371\/journal.pone.0150737","article-title":"Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study","volume":"11","author":"Guerrero","year":"2016","journal-title":"PLoS ONE"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1183\/13993003.00426-2016","article-title":"Readmission in COPD patients: Should we consider it a marker of quality of care or a marker of a more severe disease with a worse prognosis?","volume":"48","author":"Crisafulli","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.rmed.2018.01.008","article-title":"Hospitalizations due to exacerbations of COPD: A big data perspective","volume":"145","author":"Roman","year":"2018","journal-title":"Respir. Med."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Hasegawa, W., Yamauchi, Y., Yasunaga, H., Sunohara, M., Jo, T., Matsui, H., Fushimi, K., Takami, K., and Nagase, T. (2014). Factors affecting mortality following emergency admission for chronic obstructive pulmonary disease. BMC Pulm. Med., 14.","DOI":"10.1186\/1471-2466-14-151"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1136\/thx.2005.040527","article-title":"Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease","volume":"60","year":"2005","journal-title":"Thorax"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1183\/09031936.05.00024804","article-title":"Factors affecting survival of hospitalised patients with COPD","volume":"26","author":"Gunen","year":"2005","journal-title":"Eur. Respir. J."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1183\/09031936.00133805","article-title":"Mortality in COPD: Role of comorbidities","volume":"28","author":"Sin","year":"2006","journal-title":"Eur. Respir. J."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1016\/j.rmed.2013.05.001","article-title":"Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort","volume":"107","author":"Miller","year":"2013","journal-title":"Respir. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1164\/rccm.201711-2239OC","article-title":"Exacerbations of Chronic Obstructive Pulmonary Disease and Cardiac Events. A Post Hoc Cohort Analysis from the SUMMIT Randomized Clinical Trial","volume":"198","author":"Kunisaki","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1136\/thx.2010.153122","article-title":"Elevated high-sensitivity cardiac troponin T is associated with increased mortality after acute exacerbation of chronic obstructive pulmonary disease","volume":"66","author":"Hoiseth","year":"2011","journal-title":"Thorax"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"26s","DOI":"10.1183\/09031936.03.00030103","article-title":"Respiratory failure in chronic obstructive pulmonary disease","volume":"47","author":"Calverley","year":"2003","journal-title":"Eur. Respir. J. Suppl."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12931-015-0319-y","article-title":"Utilization due to chronic obstructive pulmonary disease and its predictors: A study using the U.S. National Emergency Department Sample (NEDS)","volume":"17","author":"Singh","year":"2016","journal-title":"Respir. Res."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2361","DOI":"10.2147\/COPD.S168983","article-title":"Factors associated with hospital mortality in critically ill patients with exacerbation of COPD","volume":"13","author":"Brown","year":"2018","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Giri, M., He, L., Hu, T., Puri, A., Zheng, X., Dai, H., and Guo, S. (2022). Blood Urea Nitrogen Is Associated with In-Hospital Mortality in Critically Ill Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Propensity Score Matching Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11226709"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1001\/jama.1995.03530230038027","article-title":"Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease","volume":"274","author":"Seneff","year":"1995","journal-title":"JAMA"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1080\/17476348.2021.1851601","article-title":"Long-term noninvasive ventilation in COPD: Current evidence and future directions","volume":"15","author":"Majorski","year":"2021","journal-title":"Expert. Rev. Respir. Med."},{"key":"ref_87","first-page":"160","article-title":"Longterm non-invasive ventilation in patients with chronic obstructive pulmonary disease (COPD): 2021 Canadian Thoracic Society Clinical Practice Guideline update","volume":"5","author":"Kaminska","year":"2021","journal-title":"Can. J. Respir. Crit. Care Sleep Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e000146","DOI":"10.1136\/bmjmed-2022-000146","article-title":"Chronic hypercapnic respiratory failure and non-invasive ventilation in people with chronic obstructive pulmonary disease","volume":"1","author":"Aboussouan","year":"2022","journal-title":"BMJ Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1901003","DOI":"10.1183\/13993003.01003-2019","article-title":"European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD","volume":"54","author":"Ergan","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"397","DOI":"10.4103\/ijccm.IJCCM_61_18","article-title":"Role of domiciliary noninvasive ventilation in chronic obstructive pulmonary disease patients requiring repeated admissions with acute Type II respiratory failure: A prospective cohort study","volume":"22","author":"Suraj","year":"2018","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S2213-2600(14)70153-5","article-title":"Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: A prospective, multicentre, randomised, controlled clinical trial","volume":"2","author":"Windisch","year":"2014","journal-title":"Lancet Respir. Med."},{"key":"ref_92","first-page":"642","article-title":"A pilot trial of non-invasive home ventilation after acidotic respiratory failure in chronic obstructive pulmonary disease","volume":"14","author":"Cheung","year":"2010","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1136\/thoraxjnl-2014-205126","article-title":"Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratoryfailure: A randomised, controlled, parallel-group study","volume":"69","author":"Struik","year":"2014","journal-title":"Thorax"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1111\/crj.13419","article-title":"Long-term home non-invasive ventilation in chronic hypercapnic chronic obstructive pulmonary disease patients: Real-world impact on lung function, acute exacerbations and survival","volume":"15","author":"Freitas","year":"2021","journal-title":"Clin. Respir. J."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"5137","DOI":"10.21037\/apm-20-2017","article-title":"Efficacy of domiciliary noninvasive ventilation on clinical outcomes in posthospital chronic obstructive pulmonary disease patients: A meta-analysis of randomized controlled trials","volume":"10","author":"He","year":"2021","journal-title":"Ann. Palliat. Med."},{"key":"ref_96","first-page":"CD002878","article-title":"Chronic non-invasive ventilation for chronic obstructive pulmonary disease","volume":"8","author":"Raveling","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1602426","DOI":"10.1183\/13993003.02426-2016","article-title":"Official ERS\/ATS clinical practice guidelines: Noninvasive ventilation for acute respiratory failure","volume":"50","author":"Rochwerg","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.2147\/COPD.S365771","article-title":"New Perspectives on Chronic Obstructive Pulmonary Disease","volume":"17","author":"Celli","year":"2022","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"2101574","DOI":"10.1183\/13993003.01574-2021","article-title":"ERS clinical practice guidelines: High-flow nasal cannula in acute respiratory failure","volume":"59","author":"Oczkowski","year":"2022","journal-title":"Eur. Respir. J."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"2178600","DOI":"10.1080\/20018525.2023.2178600","article-title":"The Danish respiratory society guideline for long-term high flow nasal cannula treatment, with or without supplementary oxygen","volume":"10","author":"Weinreich","year":"2023","journal-title":"Eur. Clin. Respir. J."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1164\/rccm.202210-1877LE","article-title":"Efficacy of High-Flow Nasal Cannula Oxygen Therapy in Reducing Future Exacerbations for Patients with Stable Hypercapnia with Chronic Obstructive Pulmonary Disease","volume":"207","author":"He","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/s13613-019-0551-6","article-title":"Extracorporeal carbon dioxide removal for acute hypercapnic respiratory failure","volume":"9","author":"Artigas","year":"2019","journal-title":"Ann. Intensive Care"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1055\/s-0042-1749450","article-title":"Mechanical Ventilation during ECMO: Lessons from Clinical Trials and Future Prospects","volume":"43","author":"Fior","year":"2022","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_104","first-page":"4922","article-title":"Extracorporeal membrane oxygenation (ECMO) for acute exacerbations of chronic obstructive pulmonary disease: Care modalities, experience, and precautions","volume":"13","author":"Wang","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1783857","DOI":"10.1155\/2017\/1783857","article-title":"Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure","volume":"2017","author":"Zhang","year":"2017","journal-title":"Can. Respir. J."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/00002480-197700230-00005","article-title":"The carbon dioxide membrane lung (CDML): A new concept","volume":"23","author":"Kolobow","year":"1977","journal-title":"Trans. Am. Soc. Artif. Intern. Organs"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.4187\/respcare.06277","article-title":"Extracorporeal Lung Support for Hypercapnic Ventilatory Failure","volume":"63","author":"Pisani","year":"2018","journal-title":"Respir. Care"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1007\/s00134-016-4452-y","article-title":"The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): Multicentre case-control study","volume":"42","author":"Braune","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1186\/s13063-021-05692-w","article-title":"Extracorporeal carbon dioxide removal for treatment of exacerbated chronic obstructive pulmonary disease (ORION): Study protocol for a randomised controlled trial","volume":"22","author":"Tonetti","year":"2021","journal-title":"Trials"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13561-021-00329-9","article-title":"Cost analysis of chronic obstructive pulmonary disease (COPD): A systematic review","volume":"11","year":"2021","journal-title":"Health Econ. Rev."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1164\/rccm.202109-2035OC","article-title":"Impact of Positive Airway Pressure Therapy Adherence on Outcomes in Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease","volume":"206","author":"Sterling","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/resp.14328","article-title":"Chronic obstructive pulmonary disease (COPD) mortality trends worldwide: An update to 2019","volume":"27","author":"Mei","year":"2022","journal-title":"Respirology"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/s12931-022-02242-z","article-title":"The burden of chronic obstructive pulmonary disease and its attributable risk factors in the Middle East and North Africa region, 1990\u20132019","volume":"23","author":"Feizi","year":"2022","journal-title":"Respir. Res."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"e1091","DOI":"10.1002\/hsr2.1091","article-title":"Burden and risk factors of chronic respiratory diseases in Nepal, 1990\u20132019: An analysis of the global burden of diseases study","volume":"6","author":"Dhikari","year":"2023","journal-title":"Health Sci. Rep."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e069679","DOI":"10.1136\/bmj-2021-069679","article-title":"Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990\u20132019: Results from the Global Burden of Disease Study 2019","volume":"378","author":"Safiri","year":"2022","journal-title":"BMJ"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5588\/ijtld.22.0249","article-title":"Outdoor air pollution and respiratory health","volume":"27","author":"Maio","year":"2023","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"D\u0105browiecki, P., Chcia\u0142owski, A., D\u0105browiecka, A., Pi\u00f3rkowska, A., and Badyda, A. (2023). Air pollution and long-term risk of hospital admission due to chronic obstructive pulmonary disease exacerbations in Poland: A time-stratified, case-crossover study. Pol. Arch. Intern. Med., 16444.","DOI":"10.20452\/pamw.16444"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1007\/s00011-022-01594-y","article-title":"Particulate matter in COPD pathogenesis: An overview","volume":"71","author":"Kaur","year":"2022","journal-title":"Inflamm. Res."},{"key":"ref_119","first-page":"208","article-title":"Mortality and Morbidity Effects of Long-Term Exposure to Low-Level PM2.5, BC, NO2, and O3: An Analysis of European Cohorts in the ELAPSE Project","volume":"2021","author":"Brunekreef","year":"2021","journal-title":"Res. Rep. Health Eff. Inst."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/10\/3369\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:32:25Z","timestamp":1760124745000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/10\/3369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,9]]},"references-count":119,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["jcm12103369"],"URL":"https:\/\/doi.org\/10.3390\/jcm12103369","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,9]]}}}