Management of acute respiratory failure in chronic obstructive pulmonary disease

Acute respiratory failure in the setting of preexisting chronic obstructive pulmonary disease (COPD) is a common reason for hospitalization and results in the consumption of a substantial amount of health care resources. In recent years, new therapies have been proposed, and new information about older therapies has become available. Noninvasive ventilation is finding an important place as a means of avoiding tracheal intubation. The role of bacterial infection as a frequent precipitant to acute respiratory failure in COPD remains poorly defined and presumptive antibiotic therapy remains controversial. Vasodilators of the pulmonary circulation have received much attention but so far have been disappointing in this situation. The role of several other traditional therapies, such as mucolytics and methods of secretion removal, have also been challenged in recent years. In this review we focus or recent advances in the assessment and management of acute respiratory failure in the setting of pre-existing COPD.