[COPD--how to deal with an acute exacerbation].

Exacerbations in COPD patients are characterized by an acute aggravation of the condition with an increase in symptoms (labored breathing, cough, expectoration, tightness of the chest and, rarely, fever). The major cause is a bronchial infection. The medications of choice are inhalative bronchodilators, in particular beta-2 sympathomimetics and/or anticholinergic agents, together with systemic glucocorticosteroids, and also theophylline. COPD patients experiencing exacerbations and showing clinical signs of bacterial airway infection can benefit from antibiotic treatment. In the presence of an acute partial respiratory insufficiency, administration of oxygen is indicated, while respiratory insufficiency with hypercapnea and acidosis necessitates the use of noninvasive positive pressure ventilation. For the prevention of acute exacerbations, risk factors must be eliminated, in particular cigarette smoking. Furthermore, optimized management including structured patient education is to be recommended.