Answers to 5 common questions about acute exacerbations of COPD.

Because acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are major causes of morbidity and mortality in COPD, they must be prevented when possible and when they occur, treated aggressively. This article answers 5 of the most common questions I receive about AECOPDs: 1) Are worsening respiratory symptoms an acute exacerbation or disease progression? 2) What is the best first-line treatment for an AECOPD? 3) Would systemic steroids be an effective treatment? 4) When should antibiotics be considered? 5) Is it possible to prevent an AECOPD? The physician should not assume that exacerbations are part of the disease process; they can be treated and their frequency can be reduced with appropriate preventive measures. Treatment needs to be tailored to disease severity and patient risk factors, including bacterial resistance, which significantly affects patient outcomes. Studies are also showing that exacerbations can be prevented by maintenance therapy with either long-acting beta-agonists or tiotropium.