Figure 1

General scheme for management of a chronic obstructive pulmonary disease (COPD) exacerbation. Therapy is added stepwise according to the severity of the presentation. Mild exacerbations may respond to an increase in the dose and/or frequency of inhaled bronchodilators alone. Exacerbations not responding to this require systemic corticosteroids, with the addition of antibiotics if there has been a change in the character of expectorated sputum. Additional interventions such as theophylline may be required where the clinical response is still incomplete. Oxygen and/or ventilatory support may be necessary at any stage in the presence of new or established respiratory failure. Exacerbation management should also include an assessment and management of comorbidities, and the opportunity should be taken to optimise long-term therapies to reduce the risk of future exacerbations.