Treatment of COPD exacerbations. Pharmacologic options and modification of risk factors.

Exacerbations of COPD are a major source of morbidity and mortality, resulting in tremendous increases in healthcare costs. Spirometric testing of at-risk persons can help identify patients early in the disease course who may benefit from early intervention to slow the disease process. Avoidance of irritants, smoking cessation, and use of pharmacologic agents aimed at decreasing airflow obstruction are strategies for reducing the frequency and severity of exacerbations. Patients should be educated about modifiable risk factors, such as cigarette smoking, environmental exposures, improper inhaler technique, influenza and pneumonia vaccination, pulmonary rehabilitation, and use of supplemental oxygen. Early, aggressive interventions are necessary to improve quality of life, decrease hospital admissions, improve morbidity and mortality, and reduce overall healthcare costs.