Managing exacerbations of COPD: how much progress have we made?

The pharmacological treatment of exacerbations of COPD has not significantly changed in the last decades. The use of short-acting bronchodilators to improve symptoms, systemic corticosteroids to reduce inflammation and antibiotics to treat bacterial infections is the basis of treatment. Some recent studies have described different phenotypes (or endotypes) of exacerbations and identified biomarkers that may help to personalise treatment, such as purulence of sputum and point-of-care CRP to guide antibiotic treatment and blood eosinophils to guide corticosteroid treatment. Severe exacerbations also require other strategies, such as oxygen therapy, noninvasive or invasive mechanical ventilation, and high-flow oxygen. The right treatment of an exacerbation and the implementation of a discharge bundle may result in a prolonged time to the next episode, but prevention of exacerbations of COPD is also based on an optimal treatment of stable COPD, including rehabilitation and physical activity.