ABSTRACT
Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation as a result of small airway disease and parenchymal destruction, most commonly related to cigarette smoking. Exacerbation of COPD is defined as deterioration in symptoms from when the patient is clinically stable. Usually patients present with increased breathlessness, wheeze, and chest tightness. In addition, some patients have increased sputum volume and sputum purulence. The bronchial tree in patients with COPD is often chronically colonized with potential pathogens. Antibiotic therapy should be given if the patient has at least two of the following: increased breathlessness, increased sputum volume, or increased sputum purulence. Bronchodilator therapy should be optimized; nebulized bronchodilators are recommended for more severe exacerbations. In patients that, despite the medical therapy, have type 2 respiratory failures, noninvasive ventilation, doxapram 1-4 mg/min or intermittent positive pressure ventilation should be considered.
