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Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is an ever present problem in the United States. Characterized by features of both bronchitis and emphysema, the course is generally slow and progressive. However, acute exacerbations do occur, averaging one to four exacerbations per patient per year. These exacerbations, typically characterized by increasing dyspnea, cough, and sputum production, often require immediate treatment. As single agents, both anticholinergic and β-adrenergic agents have been proven effective in acute COPD exacerbations, yet their combination may provide little added therapeutic effect over either agent alone. In light of questionable effectiveness and the potential for toxicity, the role of methylxanthines in the management of COPD has been critically evaluated over the past several years. Certain patients may show improvement from the use of corticosteroids and/or antibiotics during an acute exacerbation; however, these patients are not always easily identifiable. Lastly, patients presenting with a PaO2 < 60 mm Hg will usually benefit from oxygen therapy. This article discusses some of the current views on the efficacy of these various treatments for acute COPD exacerbations.