[Therapy of exacerbated COPD. How long ambulatory treatment?]

Acute exacerbation of COPD impacts negatively on the prognosis, and is associated with a significant motality rate. Accordingly, every case of COPD exacerbation requires intensified treatment of the underlying disease. This usually ecompasses the use of inhalative and possibly also systemic bronchodilators, and systemic glucocorticosteroids at appropriate doses. Evidence of infection (purulent sputum) indicates the need for an antibiotic, the choice of which must be determined by the severity of the underlying disease. Respiratory insufficiency requires the additional use of oxygen and, where necessary, mechanical ventilation. In such cases, non-invasive ventilation via a mask has resulted in an appreciable reduction in the complications associated with invasive ventilation, and a significant reduction in the associated high mortality rates. Successful treatment of COPD exacerbation must be followed by suitable measures aimed at reducing future episodes of exacerbation. These includes smoking cessation, optimal medical treatment and vaccination against influenza, together with appropriate patient instruction.