Definition of Chronic Obstructive Pulmonary Disease Exacerbation: The Essentials of the Rome Proposal.

Abstract

It is identical to the Creative Commons Attribution NonCommercial License (http:// creativecommons.org/licenses/ by-nc/4.0/). Last year, a group of experts on chronic obstructive pulmonary disease (COPD) proposed an updated definition of COPD exacerbation. They reached a consensus on the new definition using a modified Delphi method and named it ‘the Rome Proposal’ (Table 1). As a correct definition of COPD exacerbation is necessary not only for clinical practice but also for healthcare decisions, the Rome Proposal was designed to overcome the shortcomings of the current definition of COPD exacerbation documented by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy. One of the shortcomings of the GOLD definition is that it relies only on subjective symptoms, which can be mimicked by pneumonia, heart failure, or pulmonary thromboembolism. In contrast, in the Rome Proposal, the experts suggested objective measurements of respiratory rate, heart rate, serum C-reactive protein, pulse oximetry, and arterial blood gas in addition to the symptoms. The Rome Proposal also suggests the evaluation of differential diagnosis and etiologic testing for airway insult and removes the term, “additional therapy” from the definition of COPD exacerbation. This is because an additional therapy may differ across COPD patients due to its availability and the preference of patients or physicians upon COPD exacerbation. However, a good definition should be concise, with the exclusion of non-essential components, and must be composed of two parts—genus (category of concept) and differentia (differentiating characteristics). A good definition of COPD exacerbation is fundamental for precise communication among healthcare professionals, patients, medical students, and even the general public. Considering the com-