COPD: Management of acute exacerbations and chronic stable disease

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.