P. G. Woodruff, R. G. Barr, E. Bleecker, S. A. Christenson, D. Couper et al., Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function, N Engl J Med. 12 mai, vol.374, pp.1811-1832, 2016.

E. A. Regan, D. A. Lynch, D. Curran-everett, J. L. Curtis, J. Austin et al., Clinical and Radiologic Disease in Smokers With Normal Spirometry, JAMA Intern Med. sept, vol.175, issue.9, pp.1539-1588, 2015.

P. W. Jones, G. Harding, P. Berry, I. Wiklund, W. Chen et al., Development and first validation of the COPD Assessment Test, Eur Respir J. sept, vol.34, issue.3, pp.648-54, 2009.

J. R. Hurst, J. Vestbo, A. Anzueto, N. Locantore, H. Müllerova et al., Susceptibility to exacerbation in chronic obstructive pulmonary disease, N Engl J Med. 16 sept, vol.363, issue.12, pp.1128-1166, 2010.

, Gold Reports for Personal Use

, Global Initiative for Chronic Obstructive Lung Disease -GOLD

D. Adeloye, S. Chua, C. Lee, C. Basquill, A. Papana et al., Global and regional estimates of COPD prevalence: Systematic review and meta-analysis, J Glob Health. déc, vol.5, issue.2, p.20415, 2015.

, Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study, GBD 2013 Mortality and Causes of Death Collaborators, vol.385, pp.117-71, 2013.

A. D. Lopez, K. Shibuya, C. Rao, C. D. Mathers, A. L. Hansell et al., Chronic obstructive pulmonary disease: current burden and future projections, Eur Respir J. févr, vol.27, issue.2, pp.397-412, 2006.

, WHO | Projections of mortality and causes of death, <br>2016 to, p.2060

S. Jouneau, M. Dres, A. Guerder, N. Bele, A. Bellocq et al., Management of acute exacerbations of chronic obstructive pulmonary disease (COPD), Rev Mal Respir. avr, vol.34, issue.4, pp.282-322, 2017.
URL : https://hal.archives-ouvertes.fr/hal-01821394

W. Domej, K. Oettl, and W. Renner, Oxidative stress and free radicals in COPD--implications and relevance for treatment, Int J Chron Obstruct Pulmon Dis, vol.9, pp.1207-1231, 2014.

R. A. Stockley, Neutrophils and protease/antiprotease imbalance, Am J Respir Crit Care Med. nov, vol.160, issue.5, pp.49-52, 1999.

P. J. Barnes, Inflammatory mechanisms in patients with chronic obstructive pulmonary disease, J Allergy Clin Immunol, vol.138, issue.1, pp.16-27, 2016.

A. Churg, H. Tai, T. Coulthard, R. Wang, and J. L. Wright, Cigarette smoke drives small airway remodeling by induction of growth factors in the airway wall, Am J Respir Crit Care Med. 15 déc, vol.174, issue.12, pp.1327-1361, 2006.

J. C. Hogg, J. E. Mcdonough, J. V. Gosselink, and S. Hayashi, What drives the peripheral lungremodeling process in chronic obstructive pulmonary disease?, Proc Am Thorac Soc. déc, vol.6, issue.8, pp.668-72, 2009.

S. I. Rennard, K. Wachenfeldt, and . Von, Rationale and emerging approaches for targeting lung repair and regeneration in the treatment of chronic obstructive pulmonary disease, Proc Am Thorac Soc. août, vol.8, issue.4, pp.368-75, 2011.

S. Adnot, V. Amsellem, L. Boyer, M. E. Saker, M. Houssaini et al., Telomere Dysfunction and Cell Senescence in Chronic Lung Diseases: Therapeutic Potential, Pharmacol Ther. sept, vol.153, pp.125-159, 2015.

F. J. Martinez, L. M. Fabbri, G. T. Ferguson, C. Orevillo, P. Darken et al., Baseline Symptom Score Impact on Benefits of Glycopyrrolate/Formoterol Metered Dose Inhaler in COPD, Chest, vol.152, issue.6, pp.1169-78, 2017.

C. Vogelmeier, B. Hederer, T. Glaab, H. Schmidt, M. Rutten-van-mölken et al., Tiotropium versus salmeterol for the prevention of exacerbations of COPD, N Engl J Med. 24 mars, vol.364, issue.12, pp.1093-103, 2011.

J. A. Wedzicha, M. Miravitlles, J. R. Hurst, P. Calverley, R. K. Albert et al., Management of COPD, vol.49, issue.3, 2017.

B. Burrows, W. Bloom, J. , A. Traver, G. et al., The Course and Prognosis of Different Forms of Chronic Airways Obstruction in a Sample from the General Population, The New England journal of medicine. 1 déc, vol.317, pp.1309-1323, 1987.

G. C. Donaldson, . Seemungal-t-a.-r, A. Bhowmik, and J. A. Wedzicha, Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease, Thorax, vol.57, issue.10, pp.847-52, 2002.

T. A. Seemungal, G. C. Donaldson, E. A. Paul, J. C. Bestall, D. J. Jeffries et al., Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease, Am J Respir Crit Care Med. mai, vol.157, issue.5, pp.1418-1440, 1998.

M. Miravitlles, M. Ferrer, A. Pont, R. Zalacain, J. L. Alvarez-sala et al., Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study, Thorax. mai, vol.59, issue.5, pp.387-95, 2004.

R. M. Abdulai, T. J. Jensen, N. R. Patel, M. I. Polkey, P. Jansson et al., Deterioration of Limb Muscle Function during Acute Exacerbation of Chronic Obstructive Pulmonary Disease, Am J Respir Crit Care Med, vol.15, issue.4, pp.433-482, 2018.

M. Hoogendoorn, R. T. Hoogenveen, M. Moelken, J. Vestbo, T. L. Feenstra et al., Case fatality of COPD exacerbations: a meta-analysis and statistical modelling approach, European Respiratory Journal. mars, vol.37, issue.3, pp.508-523, 2011.

J. Piquet, J. Chavaillon, P. David, F. Martin, F. Blanchon et al., High-risk patients following hospitalisation for an acute exacerbation of COPD, Eur Respir J. oct, vol.42, issue.4, pp.946-55, 2013.

A. Singanayagam, S. Schembri, and J. D. Chalmers, Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease, Ann Am Thorac Soc. avr, vol.10, issue.2, pp.81-90, 2013.

Y. Guo, T. Zhang, Z. Wang, F. Yu, Q. Xu et al., Body mass index and mortality in chronic obstructive pulmonary disease: A dose-response meta-analysis, Medicine (Baltimore). juill, vol.95, issue.28, p.4225, 2016.

J. Garcia-aymerich, S. Pons, I. Mannino, D. M. Maas, A. K. Miller et al., Lung function impairment, COPD hospitalisations and subsequent mortality, Thorax. juill, vol.66, issue.7, pp.585-90, 2011.

R. J. Halbert, J. L. Natoli, A. Gano, E. Badamgarav, A. S. Buist et al., Global burden of COPD: systematic review and meta-analysis, Eur Respir J. sept, vol.28, issue.3, pp.523-555, 2006.

W. H. Van-geffen, W. R. Douma, D. J. Slebos, and H. Kerstjens, Bronchodilators delivered by nebuliser versus pMDI with spacer or DPI for exacerbations of COPD, Cochrane Database Syst Rev. 29 août, issue.8, p.11826, 2016.

F. Maltais, J. Ostinelli, J. Bourbeau, A. B. Tonnel, N. Jacquemet et al., Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial, Am J Respir Crit Care Med. 1 mars, vol.165, issue.5, pp.698-703, 2002.

H. Gunen, S. S. Hacievliyagil, O. Yetkin, G. Gulbas, L. C. Mutlu et al., The role of nebulised budesonide in the treatment of exacerbations of COPD, European Respiratory Journal. 1 avr, vol.29, issue.4, pp.660-667, 2007.

B. Ställberg, O. Selroos, C. Vogelmeier, E. Andersson, T. Ekström et al.,

, Budesonide/formoterol as effective as prednisolone plus formoterol in acute exacerbations of COPD A double-blind, randomised, non-inferiority, parallel-group, multicentre study, Respir Res, vol.10, issue.1, p.11, 2009.

Z. Ding, X. Li, Y. Lu, G. Rong, R. Yang et al., A randomized, controlled multicentric study of inhaled budesonide and intravenous methylprednisolone in the treatment on acute exacerbation of chronic obstructive pulmonary disease, Respir Med, vol.121, pp.39-47, 2016.

D. Stolz, H. H. Hirsch, D. Schilter, R. Louis, J. Rakic et al., Intensified Therapy with Inhaled Corticosteroids and Long-Acting ?2-Agonists at the Onset of Upper Respiratory Tract Infection to Prevent Chronic Obstructive Pulmonary Disease Exacerbations. A Multicenter, Randomized, Double-Blind, Placebo-controlled Trial, Am J Respir Crit Care Med, vol.197, issue.9, pp.1136-1182, 2018.

T. M. Mckeever, G. Hearson, G. Housley, C. Reynolds, W. Kinnear et al., Using venous blood gas analysis in the assessment of COPD exacerbations: a prospective cohort study, Thorax. mars, vol.71, issue.3, pp.210-215, 2016.

A. L. Byrne, M. Bennett, R. Chatterji, R. Symons, N. L. Pace et al., Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis, Respirology. févr, vol.19, issue.2, pp.168-75, 2014.

M. Ekström, A. Engblom, A. Ilic, N. Holthius, P. Nordström et al., Calculated arterial blood gas values from a venous sample and pulse oximetry: Clinical validation, PLoS ONE, vol.14, issue.4, p.215413, 2019.

K. Nagata, T. Kikuchi, T. Horie, A. Shiraki, T. Kitajima et al., Domiciliary High-Flow Nasal Cannula Oxygen Therapy for Patients with Stable Hypercapnic Chronic Obstructive Pulmonary Disease. A Multicenter Randomized Crossover Trial, vol.15, pp.432-441, 2018.

C. R. Osadnik, V. S. Tee, K. V. Carson-chahhoud, J. Picot, J. A. Wedzicha et al., Noninvasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev, Disponible sur, vol.13, pp.521-555, 1999.

J. Sellares, M. Ferrer, A. A. Loureiro, H. Bencosme, C. Alonso et al., Discontinuing noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations: a randomised controlled trial, Eur Respir J, vol.50, issue.1, 2017.

D. Chandra, J. A. Stamm, B. Taylor, R. M. Ramos, L. Satterwhite et al., Outcomes of Noninvasive Ventilation for Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the United States, Am J Respir Crit Care Med. 15 janv, vol.185, issue.2, pp.152-161, 1998.

M. A. Puhan, E. Gimeno-santos, M. Scharplatz, T. Troosters, E. H. Walters et al., Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease, Cochrane Database Syst Rev, issue.10, p.5305, 2011.

R. E. Jordan, S. Majothi, N. R. Heneghan, D. B. Blissett, R. D. Riley et al., Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis, Health Technol Assess. mai, vol.19, issue.36, pp.1-516, 2015.

R. Gavish, A. Levy, O. K. Dekel, E. Karp, and N. Maimon, The Association Between Hospital Readmission and Pulmonologist Follow-up Visits in Patients With COPD, Chest. août, vol.148, issue.2, pp.375-81, 2015.

M. Martínez-garcía, R. Carrillo, D. Soler-cataluña, J. Donat-sanz, Y. Serra et al., Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease, Am J Respir Crit Care Med. 15 avr, vol.187, issue.8, pp.823-854, 2013.

A. Haruna, S. Muro, Y. Nakano, T. Ohara, Y. Hoshino et al., CT scan findings of emphysema predict mortality in COPD, Chest. sept, vol.138, issue.3, pp.635-675, 2010.

R. M. Van-der-meer, E. J. Wagena, R. Ostelo, J. E. Jacobs, and C. P. Van-schayck, Smoking cessation for chronic obstructive pulmonary disease, Cochrane Database Syst Rev, issue.2, p.2999, 2003.

H. Mcrobbie, C. Bullen, J. Hartmann-boyce, and P. Hajek, Electronic cigarettes for smoking cessation and reduction, Cochrane Database Syst Rev, issue.12, p.10216, 2014.

D. P. Tashkin, S. Rennard, J. T. Hays, W. Ma, D. Lawrence et al., Effects of varenicline on smoking cessation in patients with mild to moderate COPD: a randomized controlled trial, Chest. mars, vol.139, issue.3, pp.591-600, 2011.

L. F. Stead, P. Koilpillai, T. R. Fanshawe, and T. Lancaster, Combined pharmacotherapy and behavioural interventions for smoking cessation, Cochrane Database Syst Rev. 24 mars, vol.3, p.8286, 2016.

P. Wongsurakiat, K. N. Maranetra, C. Wasi, U. Kositanont, W. Dejsomritrutai et al., Acute respiratory illness in patients with COPD and the effectiveness of influenza vaccination: a randomized controlled study, Chest. juin, vol.125, issue.6, pp.2011-2031, 2004.

K. L. Nichol, K. L. Margolis, J. Wuorenma, V. Sternberg, and T. , The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community, N Engl J Med. 22 sept, vol.331, issue.12, pp.778-84, 1994.

J. A. Walters, J. Tang, P. Poole, and R. Wood-baker, Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease, Cochrane Database Syst Rev, vol.24, p.1390, 2017.

J. B. Geake, E. J. Dabscheck, R. Wood-baker, and C. J. Cates, Indacaterol, a once-daily beta2-agonist, versus twice-daily beta?-agonists or placebo for chronic obstructive pulmonary disease, Cochrane Database Syst Rev. 10 janv, vol.1, p.10139, 2015.

C. Karner, J. Chong, and P. Poole, Tiotropium versus placebo for chronic obstructive pulmonary disease, Cochrane Database Syst Rev. 11 juill, issue.7, p.9285, 2012.

J. A. Wedzicha, M. Decramer, J. H. Ficker, D. E. Niewoehner, T. Sandström et al., Analysis of chronic obstructive pulmonary disease exacerbations with the dual bronchodilator QVA149 compared with glycopyrronium and tiotropium (SPARK): a randomised, double-blind, parallel-group study, Lancet Respir Med. mai, vol.1, issue.3, pp.199-209, 2013.

I. A. Yang, M. S. Clarke, E. Sim, and K. M. Fong, Inhaled corticosteroids for stable chronic obstructive pulmonary disease, Cochrane Database Syst Rev. 11 juill, issue.7, p.2991, 2012.

L. J. Nannini, T. J. Lasserson, and P. Poole, Combined corticosteroid and long-acting beta(2)-agonist in one inhaler versus long-acting beta(2)-agonists for chronic obstructive pulmonary disease, Cochrane Database Syst Rev. 12 sept, issue.9, p.6829, 2012.

L. J. Nannini, P. Poole, S. J. Milan, and A. Kesterton, Combined corticosteroid and long-acting beta(2)-agonist in one inhaler versus inhaled corticosteroids alone for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, p.6826, 2013.

M. Bafadhel, S. Peterson, D. Blas, M. A. Calverley, P. M. Rennard et al., Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease: a post-hoc analysis of three randomised trials, Lancet Respir Med, vol.6, issue.2, pp.117-143, 2018.

C. Crim, M. T. Dransfield, J. Bourbeau, P. W. Jones, N. A. Hanania et al., Pneumonia risk with inhaled fluticasone furoate and vilanterol compared with vilanterol alone in patients with COPD, Ann Am Thorac Soc. janv, vol.12, issue.1, pp.27-34, 2015.

K. R. Chapman, J. R. Hurst, S. Frent, M. Larbig, R. Fogel et al., Long-Term Triple Therapy De-escalation to Indacaterol/Glycopyrronium in Patients with Chronic Obstructive Pulmonary Disease (SUNSET): A Randomized, Double-Blind, Triple-Dummy Clinical Trial, Am J Respir Crit Care Med. 1 août, vol.198, issue.3, pp.329-368, 2018.

R. N. Johnston, R. S. Mcneill, D. H. Smith, M. B. Dempster, J. R. Nairn et al., Fiveyear winter chemoprophylaxis for chronic bronchitis, Br Med J, vol.4, issue.5678, pp.265-274, 1969.

R. S. Francis and C. C. Spicer, Chemotherapy in chronic bronchitis. Influence of daily penicillin and tetracycline on exacerbations and their cost, Br Med J. 30 janv, vol.1, issue.5169, pp.297-303, 1960.

S. Uzun, R. S. Djamin, J. Kluytmans, P. Mulder, N. E. Van&apos;t-veer et al., Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebocontrolled trial, Lancet Respir Med. mai, vol.2, issue.5, pp.361-369, 2014.

T. Seemungal, T. Wilkinson, J. R. Hurst, W. R. Perera, R. J. Sapsford et al., Long-term erythromycin therapy is associated with decreased chronic obstructive pulmonary disease exacerbations, Am J Respir Crit Care Med. 1 déc, vol.178, issue.11, pp.1139-1186, 2008.

M. K. Han, N. Tayob, S. Murray, M. T. Dransfield, G. Washko et al., Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy, Am J Respir Crit Care Med. 15 juin, vol.189, issue.12, pp.1503-1511, 2014.

J. A. Wedzicha, P. Calverley, R. K. Albert, A. Anzueto, G. J. Criner et al., Prevention of COPD exacerbations, European Respiratory Journal. 1 sept, vol.50, issue.3, p.1602265, 2017.


H. Autorité-de-santé,

D. Sur,

S. I. Rennard, C. Fogarty, S. Kelsen, W. Long, J. Ramsdell et al., The safety and efficacy of infliximab in moderate to severe chronic obstructive pulmonary disease, Am J Respir Crit Care Med. 1 mai, vol.175, issue.9, pp.926-960, 2007.

G. J. Criner, J. E. Connett, S. D. Aaron, R. K. Albert, W. C. Bailey et al., Simvastatin for the Prevention of Exacerbations in Moderate-to-Severe COPD, New England Journal of Medicine. 5 juin, vol.370, issue.23, pp.2201-2211, 2014.

T. S. Ingebrigtsen, J. L. Marott, B. G. Nordestgaard, P. Lange, J. Hallas et al., Statin use and exacerbations in individuals with chronic obstructive pulmonary disease, Thorax. janv, vol.70, issue.1, pp.33-40, 2015.

I. Vogiatzis, C. L. Rochester, M. A. Spruit, T. Troosters, and E. M. Clini, European Respiratory Society Task Force on Policy in Pulmonary Rehabilitation. Increasing implementation and delivery of pulmonary rehabilitation: key messages from the new ATS/ERS policy statement, Eur Respir J, vol.47, issue.5, pp.1336-1377, 2016.

J. A. Alison, Z. J. Mckeough, K. Johnston, R. J. Mcnamara, L. M. Spencer et al., Australian and New Zealand Pulmonary Rehabilitation Guidelines, Respirology, vol.22, issue.4, pp.800-819, 2017.

S. Bourne, R. Devos, M. North, A. Chauhan, B. Green et al., Online versus faceto-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial, BMJ Open. 1 juill, vol.7, issue.7, p.14580, 2017.

T. W. Effing, J. H. Vercoulen, J. Bourbeau, J. Trappenburg, A. Lenferink et al., Definition of a COPD self-management intervention: International Expert Group consensus, European Respiratory Journal. 1 juill, vol.48, issue.1, pp.46-54, 2016.

A. Lenferink, M. Brusse-keizer, P. D. Van-der-valk, P. A. Frith, M. Zwerink et al., Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease, Cochrane Database Syst Rev. 4 août, vol.8, p.11682, 2017.

R. Kessler, P. Casan-clara, D. Koehler, S. Tognella, J. L. Viejo et al., COMET: a multicomponent home-based disease-management programme versus routine care in severe COPD, European Respiratory Journal. 1 janv, vol.51, issue.1, p.1701612, 2018.

M. Cazzola, L. Calzetta, C. Page, J. Jardim, A. G. Chuchalin et al., Influence of Nacetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis, Eur Respir Rev. sept, vol.24, issue.137, pp.451-61, 2015.

P. Poole, J. Chong, and C. J. Cates, Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease, Cochrane Database Syst Rev. 29 juill, issue.7, p.1287, 2015.

H. Gunen, G. Gulbas, E. In, O. Yetkin, and S. S. Hacievliyagil, Venous thromboemboli and exacerbations of COPD, Eur Respir J. juin, vol.35, issue.6, pp.1243-1251, 2010.

M. Woodhead, F. Blasi, S. Ewig, J. Garau, G. Huchon et al., Guidelines for the management of adult lower respiratory tract infections--full version, Clin Microbiol Infect, vol.17, issue.6, pp.1-59, 2011.

F. Ko, M. Ip, P. Chan, J. Fok, M. Chan et al., A 1-year prospective study of the infectious etiology in patients hospitalized with acute exacerbations of COPD, Chest. janv, vol.131, issue.1, pp.44-52, 2007.

, Professionnels de santé au 1 er janvier 2017 | Insee

D. Sur,

J. Piquet, J. Chavaillon, P. David, F. Martin, D. Braun et al., Characteristics and management of acute exacerbations of COPD in hospital. EABPCO-CPHG study by the college of general hospital respiratory physicians, Rev Mal Respir, vol.27, issue.1, pp.19-29, 2010.

M. S. Skorodin, M. F. Tenholder, B. Yetter, K. A. Owen, R. F. Waller et al., Magnesium sulfate in exacerbations of chronic obstructive pulmonary disease, Arch Intern Med. 13 mars, vol.155, issue.5, pp.496-500, 1995.

H. J. Alter, T. D. Koepsell, and W. M. Hilty, Intravenous magnesium as an adjuvant in acute bronchospasm: a meta-analysis, Ann Emerg Med. sept, vol.36, issue.3, pp.191-198, 2000.

J. Durlach, N. Pagès, P. Bac, M. Bara, and A. Guiet-bara, Beta-2 mimetics and magnesium: true or false friends?, Magnes Res. sept, vol.16, issue.3, pp.218-251, 2003.

M. C. Shivanthan and S. Rajapakse, Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials, Ann Thorac Med. avr, vol.9, issue.2, pp.77-80, 2014.

D. E. Niewoehner, M. L. Erbland, R. H. Deupree, D. Collins, N. J. Gross et al., Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group, N Engl J Med. 24 juin, vol.340, issue.25, pp.1941-1948, 1999.

L. Davies, R. M. Angus, and P. M. Calverley, Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial, Lancet. 7 août, vol.354, issue.9177, pp.456-60, 1999.

M. Bafadhel, S. Mckenna, S. Terry, V. Mistry, M. Pancholi et al., Blood eosinophils to direct corticosteroid treatment of exacerbations of chronic obstructive pulmonary disease: a randomized placebo-controlled trial, Am J Respir Crit Care Med. 1 juill, vol.186, issue.1, pp.48-55, 2012.

D. Seys, L. Bruyneel, M. Decramer, C. Lodewijckx, M. Panella et al., An International Study of Adherence to Guidelines for Patients Hospitalised with a COPD Exacerbation, COPD. avr, vol.14, issue.2, pp.156-63, 2017.

C. M. Roberts, J. L. Lopez-campos, F. Pozo-rodriguez, and S. Hartl, Résumé : Introduction : Les exacerbations de BPCO (EABPCO) représentent un poids économique lourd pour notre système de santé et aggravent le pronostic de la maladie. C'est également le meilleur facteur prédictif d'exacerbations ultérieures. Le traitement des EABPCO est bien codifié et repose sur les recommandations des sociétés savantes nationales et internationales. La prévention des EABPCO doit être systématique et passe par l'arrêt du tabac, les vaccins, le traitement de fond, Team on behalf of the ECA, vol.68, pp.1169-71, 2013.

, Une première analyse a été réalisée en diffusant des recommandations locales en 2011. Nous avons analysé les pratiques professionnelles à distance de la diffusion des recommandations afin d'évaluer le degré de persistance de l'adhérence des pratiques cliniques aux recommandations. Cela a été réalisé par une étude rétrospective, Matériels et méthodes : L'évaluation des pratiques professionnelles, 2016.

, La prescription de salbutamol a diminué significativement (p<0.001) en période 3 (4%) par rapport à la période 1 (59%) alors que la prescription de sulfate de magnésium intraveineux a augmenté en période 3 (34,9%) par rapport à la période 2 (12,9%) sans être significatif (p=0.091). La prescription d'aérosols a globalement diminué de J1 à J5 en période 3 par rapport aux périodes 1 et 2. La corticothérapie à dose recommandée a, Résultats : Un total de 189 patients a été inclus dont 32 en période 1 (entre 2010 et 2011, soit l'année précédant la diffusion des recommandations)

, La consultation anti-tabac post-exacerbation avait diminué significativement en période 3 (6,8% des patients non sevrés) mais le nombre de patients ayant eu un sevrage tabagique après l'hospitalisation avait légèrement progressé en période 3 (18,6%). La consultation pneumologique de suivi a été réalisée chez 73% des patients, L'antibiothérapie prescrite selon les recommandations s'est améliorée en période 3 (88,1%) par rapport à la période 1 (62,5%) et la période 2 (87,1%)

, Discussion: Les pratiques professionnelles en accord avec les recommandations persistent en partie à distance. Le sulfate de magnésium, la kinésithérapie, la réalisation des antigénuries et l'organisation du suivi après l'hospitalisation après l'hospitalisation nécessitent une harmonisation avec les recommandations. Une mise à jour régulière des connaissances et la réalisation d'EPP

, Mots-clés: BPCO, exacerbation, évaluation, pratiques professionnelles, recommandations