Acute exacerbations of COPD: A "multipronged" approach

The global burden of chronic obstructive pulmonary disease (COPD) is increasing steadily. Acute exacerbations contribute substantially to the morbidity and mortality associated with COPD. Recent studies have shown that acute exacerbations also contribute to the decline in forced expiratory volume in 1 second and impaired quality of life. The cardinal symptoms of an exacerbation are increased dyspnea, sputum production, and sputum purulence. When a patient presents with such symptoms, it is important to exclude other diseases, such as congestive heart failure and pneumonia. A careful clinical evaluation is usually adequate. In selected patients, chest radiography, sputum culture, and arterial blood gas measurement are indicated. A multipronged approach to treatment is necessary and may include bronchodilators, oxygen supplementation, antibiotics, and corticosteroids. The choice of antibiotics is guided by the presence of risk factors for poor outcome.