Acute exacerbations of chronic obstructive pulmonary disease: are antibiotics needed?

Acute exacerbations are frequent complications of chronic obstructive pulmonary disease (COPD). Individuals developing COPD exacerbations usually increase the rescue use of bronchodilators (short-acting β-2 agonist and anticholinergic drugs) and are prescribed systemic corticosteroids if they do not respond. Systemic corticosteroids significantly reduce treatment failure,shorten hospital stay,and improve symptoms and lung function. Although available evidence suggests that patients with COPD who are given antibiotics receive moderate benefit,current guidelines recommend antibiotic treatment only in patients with increased dyspnea,sputum volume,and purulence (Anthonisen criteria). The most frequent causes of COPD exacerbations are believed to be viral and/or bacterial infections. However,in most cases,the etiology of a COPD exacerbation is unknown,and clinical features are of limited help in identifying the cause and particularly in distinguishing between viral and bacterial infections. Several biomarkers (e.g.,procalcitonin) have been used to diagnose acute exacerbations of COPD due to bacterial infections,with the aim of reducing the exposure of patients to antibiotics,but their role is controversial and their use is not yet recommended by guidelines.