[Exacerbations of COPD--new aspects in pathogenesis and therapy]

Exacerbations of COPD are a common cause of morbidity and mortality in this chronic lung disease. Many exacerbations are caused by bacterial or viral infections, but the cause of about 30% of exacerbations cannot be identified. Clinical symptoms (increased dyspnea, cough, and sputum) are due to increased inflammation of the central and peripheral airways, resulting in increased mucus production and bronchoconstriction. Home management consists of an intensive bronchodilator therapy (beta-agonists and anticholinergics), oral glucocorticosteroids and possibly antibiotics, depending on the clinical situation. Hospitalisation has to be considered if initial medical management fails, if there are significant co-morbidities or complications, or if the underlying COPD is severe. Several possibilities to prevent recurrence of COPD exacerbations are discussed.