Acute exacerbations of chronic obstructive pulmonary disease (COPD) are major causes of morbidity and mortality and contribute to disease progression. The frequency with which COPD patients experience exacerbations can differ markedly between patients, even those with a similar severity of airflow obstruction. This has led to the concept of ‘frequent exacerbators’ that represent a unique phenotype of COPD patients who experience frequent exacerbations and have poorer outcomes compared with patients with infrequent exacerbations. However, the mechanisms whereby some COPD patients experience frequent exacerbations remain undetermined. Understanding the mechanisms of frequent exacerbations will lead to the development of new therapies that can be targeted to these high-risk patients, thereby reducing exacerbations and improving outcomes.
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