Acute exacerbations of chronic obstructive pulmonary disease (COPD) are tre
ated with oxygen (in hypoxemic patients), inhaled beta, agonists, inhaled a
nticholinergics, antibiotics and systemic corticosteroids. Methylxanthine t
herapy may be considered in patients who do not respond to other bronchodil
ators. Antibiotic therapy is directed at the most common pathogens, includi
ng Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhal
is. Mild to moderate exacerbations of COPD are usually treated with older b
road-spectrum antibiotics such as doxycycline, trimethoprim-sulfamethoxazol
e and amoxicillin-clavulanate potassium. Treatment with augmented penicilli
ns, fluoroquinolones, third-generation cephalosporins or aminoglycosides ma
y be considered in patients with more severe exacerbations. The management
of chronic stable COPD always includes smoking cessation and oxygen therapy
. Inhaled beta,. agonists, inhaled anticholinergics and systemic corticoste
roids provide short-term benefits in patients with chronic stable disease.
Inhaled corticosteroids decrease airway reactivity and reduce the use of he
alth care services for management of respiratory symptoms. Preventing acute
exacerbations helps to reduce long-term complications. Long-term oxygen th
erapy, regular monitoring of pulmonary function and referral for pulmonary
rehabilitation are often indicated. Influenza and pneumococcal vaccines sho
uld be given. Patients who do not respond to standard therapies may benefit
from surgery.