Priority 7 from the COPD Exacerbation PSP

UNCERTAINTY: Why do some exacerbations recur (happen again) following treatment?  (JLA PSP Priority 7)
Overall ranking 7
JLA question ID 0104/7
Explanatory note There is evidence to suggest that in the period after a person has recovered from a first exacerbation, they are at higher risk of developing a second one.  Related to this, almost one in four patients who have been discharged from hospital after an exacerbation will be re-admitted to hospital with a month.  This question aims to understand why this happens, and find new ways to better prevent exacerbations from happening again in this 'high risk' period following recovery from the previous exacerbation. 
Evidence

The question has partially been addressed in the evidence base. https://www.nice.org.uk/guidance/ng115/evidence/e-predicting-and-preventing-exacerbations-pdf-6602768754
Health Research Classification System category  Respiratory
Extra information provided by this PSP
Original uncertainty examples

I try my best to do everything they say to help stop me getting an exacerbation but i still get them why is that?~ What is the most important factor in preventing another exacerbation- many patients focus on avoiding others with cough/colds etc but is it avoiding umes/ weather, smoking cessation or just all o these in equal measures?~ Why do I often relapse? ~ What are the mechanisms of exacerbations recurrence? ~ I follow all the advice given to prevent chest infections but I still get many in a year. My question is why? ~ why am i having flare ups constantly one after another
 
Submitted by Patient, Healthcare Professional
PSP information
PSP unique ID 0104
PSP name COPD Exacerbation PSP
Total number of uncertainties identified by this PSP. 51 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 1 April 2021