University of Wisconsin School of Medicine and Public Health, 100 N. Nine Mound Rd., Verona, WI 53593, USA.
Am Fam Physician. 2010 Mar 1;81(5):607-13.
Exacerbations of chronic obstructive pulmonary disease contribute to the high mortality rate associated with the disease. Randomized controlled trials have demonstrated the effectiveness of multiple interventions. The first step in outpatient management should be to increase the dosage of inhaled short-acting bronchodilators. Combining ipratropium and albuterol is beneficial in relieving dyspnea. Oral corticosteroids are likely beneficial, especially for patients with purulent sputum. The use of antibiotics reduces the risk of treatment failure and mortality in moderately or severely ill patients. Physicians should consider antibiotics for patients with purulent sputum and for patients who have inadequate symptom relief with bronchodilators and corticosteroids. The choice of antibiotic should be guided by local resistance patterns and the patient's recent history of antibiotic use. Hospitalized patients with exacerbations should receive regular doses of short-acting bronchodilators, continuous supplemental oxygen, antibiotics, and systemic corticosteroids. Noninvasive positive pressure ventilation or invasive mechanical ventilation is indicated in patients with worsening acidosis or hypoxemia.
慢性阻塞性肺疾病（COPD）的加重会导致该疾病的高死亡率。随机对照试验已经证明了多种干预措施的有效性。门诊管理的第一步应该是增加吸入性短效支气管扩张剂的剂量。联合使用异丙托溴铵和沙丁胺醇有助于缓解呼吸困难。口服皮质类固醇可能有益，尤其是对于脓性痰患者。抗生素的使用降低了中重度疾病患者治疗失败和死亡的风险。对于有脓性痰的患者，以及支气管扩张剂和皮质类固醇治疗后症状缓解不足的患者，医生应考虑使用抗生素。抗生素的选择应根据当地耐药模式和患者最近的抗生素使用史来指导。病情恶化的住院患者应接受常规剂量的短效支气管扩张剂、持续补充氧气、抗生素和全身皮质类固醇治疗。对于酸中毒或低氧血症恶化的患者，应使用无创正压通气或有创机械通气。
