Question 13

ABECOPD is a common problem, but there still seems to be debate about its appropriate management. What do you think?

COPD is a major global problem, and acute exacerbations can be caused by multiple factors, including bacterial and viral pathogens, environmental allergens, or co-morbidities such as congestive heart failure. Over 20 years ago, a pivotal study by Anthonisen et al. (14) identified three criteria that could be used to indicate the likelihood of a bacterial etiology. They found that if patients had increased shortness of breath, increased sputum and the presence of purulent sputum, they were likely to have a bacterial etiology, with antibiotics providing an effective therapy. If only one or two of these criteria were present, the patient had a mild exacerbation and antibiotics were not useful. Another method of assessing patients and deciding on appropriate treatment uses the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines (15).