Acute exacerbations in chronic obstructive pulmonary disease: current strategies with pharmacological therapy

In acute exacerbation of chronic obstructive pulmonary disease (AECOPD), short-acting inhaled bronchodilators, such as salbutamol (albuterol) and ipratropium bromide, have proven useful. In patients who are refractory to these agents, intravenous aminophylline should be considered. Corticosteroids should also be used, either in the outpatient or inpatient setting. The duration of corticosteroids should probably not exceed 2 weeks and the optimum dosage is yet to be determined. Antibacterials, especially in patients with purulent or increased sputum, should be used, guided by the local antibiogram of the key microbes. Controlled oxygen therapy improves outcome in hypoxaemic patients and arterial blood gases should be performed to ensure hypercarbia is not becoming excessive. Should patients be in distress despite the above measures or if there is acidaemia or hypercarbia, noninvasive positive pressure ventilation could be used to improve outcomes without resorting to invasive mechanical ventilation. Mucous-clearing drugs and chest physiotherapy have no proven beneficial role in AECOPD.