An assessment of therapeutic regimens in the treatment of acute exacerbations in chronic obstructive pulmonary disease and asthma.

Acute exacerbations in chronic obstructive pulmonary disease (COPD) and asthma are potentially life-threatening clinical events that may result in substantial morbidity and mortality. Treatment of these episodes requires the rapid reversal of airway obstruction by decreasing bronchoconstriction and inflammation. Consensus guidelines and recommendations build on stepwise approaches to care, with the mainstay of therapeutic interventions involving brochodilators and often including systemic corticosteroids, oxygen, and other treatments, depending on severity and setting. Future therapies that target inflammatory processes may offer improved efficacy and potential disease-modifying effects. The purpose of this article is to assess the treatment options for acute exacerbations in COPD and asthma within the scope of current consensus guidelines and recommendations (eg, Global Initiative for Chronic Obstructive Lung Disease, National Asthma Education and Prevention Program, Global Initiative for Asthma). Although bronchodilators and corticosteroids are the primary therapies discussed, antibiotics, oxygen, magnesium sulfate, noninvasive positive pressure ventilation, and helium/oxygen mixtures are also addressed. Preventive approaches for future exacerbations are considered in the overall approach to achieve optimal outcomes.