PT - JOURNAL ARTICLE AU - Christian Viniol AU - Claus F. Vogelmeier TI - Exacerbations of COPD AID - 10.1183/16000617.0103-2017 DP - 2018 Mar 31 TA - European Respiratory Review PG - 170103 VI - 27 IP - 147 4099 - http://err.ersjournals.com/content/27/147/170103.short 4100 - http://err.ersjournals.com/content/27/147/170103.full SO - EUROPEAN RESPIRATORY REVIEW2018 Mar 31; 27 AB - Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. While COPD is a mainly chronic disease, a substantial number of patients suffer from exacerbations. Severe exacerbations are related to a significantly worse survival outcome. This review summarises the current knowledge on the different aspects of COPD exacerbations. The impact of risk factors and triggers such as smoking, severe airflow limitation, bronchiectasis, bacterial and viral infections and comorbidities is discussed. More severe exacerbations should be treated with β-agonists and anticholinergics as well as systemic corticosteroids. Antibiotic therapy should only be given to patients with presumed bacterial infection. Noninvasive ventilation is indicated in patients with respiratory failure. Smoking cessation is key to prevent further COPD exacerbations. Other aspects include choice of pharmacotherapy, including bronchodilators, inhaled corticosteroids, phosphodiesterase-4 inhibitors, long-term antibiotics and mucolytics. Better education and self-management as well as increased physical activity are important. Influenza and pneumococcal vaccination is recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of COPD exacerbations, while most interventional bronchoscopic therapies increase exacerbation risk within the first months after the procedure.This article highlights the importance of preventing exacerbations of COPD http://ow.ly/ODQp30i5Cel