[Acute exacerbation of chronic obstructive pulmonary disease]

Exacerbation of COPD is a common problem, which causes a considerable burden to the patient and the healthcare system. Management of exacerbations is broadly based on clinical features and severity. Initial clinical evaluation is crucial to define the patients requiring hospital admissions and those that could be managed as outpatients. Medical treatment should follow updated recommendations including rest, inhaled or nebulized short-acting bronchodilators (B2-agonists and anticholinergic agents), and in most severe patients steroids unless there are contraindications and antibiotics. Hospitalized patients should receive titrated oxygen therapy, and DVT prevention. Unless contra indicated, noninvasive ventilation should be the first line ventilatory support for COPD with acute hypercapnic respiratory failure. Future exacerbations should be avoided by respiratory specialists' management.