CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Acute exacerbations of underlying COPD are a common cause of respirato ry deterioration. Developments have been made in preventive measures, but admission to hospital for acute exacerbations can be expected to r emain common. Several expert consensus guidelines have been published to define the appropriate management of COPD patients. These consensus guidelines generally agree, but all acknowledge a lack of large well- controlled clinical studies, especially studies focusing on the manage ment of acute exacerbations. Consequently, many potential controversie s exist about the details of managing patients with acute exacerbation s. Although studies of many fundamental aspects of management are stil l needed, the results of controlled clinical trials are sufficient to emphasise the importance of a careful clinical assessment, supplementa l oxygen, inhaled bronchodilators to partially improve airway obstruct ion, corticosteroids to decrease the likelihood of treatment failures and to speed recovery, antibiotics, especially in severe patients, and non-invasive positive-pressure ventilation for treatment of acute ven tilatory failure in selected patients.