Exacerbations

Exacerbation is a sudden or gradual worsening of a patient’s underlying chronic condition that is not attributable to an entirely new disease. It is often defined clinically by the emergence or worsening of symptoms beyond normal day-to-day variation and may be accompanied by objective signs or laboratory abnormalities. Exacerbations can be brief or prolonged and often require a modification of treatment, and they contribute to morbidity, healthcare utilization, and, in some conditions, mortality.

Common triggers include respiratory infections, air pollution, allergens, heat or cold stress, medication nonadherence, and concurrent illnesses. The underlying pathophysiology typically involves increased systemic or local inflammation, organ dysfunction, and inadequate compensation by the body's homeostatic mechanisms.

In chronic obstructive pulmonary disease and asthma, exacerbations present with increased breathlessness, cough, sputum production or purulence, and may require short-acting bronchodilators, systemic corticosteroids, and antibiotics when bacterial infection is suspected. In heart failure, decompensation manifests as dyspnea, edema, and fatigue, managed with diuresis, optimization of guideline-directed therapy, and treatment of precipitating factors. Other chronic diseases, including kidney disease, diabetes, and neurodegenerative conditions, can also experience acute deteriorations labeled as exacerbations.

Diagnosis relies on history, examination, and sometimes imaging or laboratory tests to identify triggers and assess severity. Management emphasizes prompt assessment, escalation of therapy, patient education, and preventive strategies such as vaccination, adherence to maintenance therapy, action plans, and avoidance of known triggers.