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Educational aims To define the importance of exacerbations in COPD and chronic bronchitis. To assess current guidelines for the treatment of COPD exacerbations. To outline current antibiotic treatments and treatment periods for exacerbations. Summary Chronic obstructive pulmonary disease (COPD) exacerbations have been associated with an increased risk of mortality and currently available therapies for exacerbations show only limited beneficial effects. Bacterial infections caused by pathogens are the predominant cause of acute exacerbations in COPD and chronic bronchitis. Current guidelines suggest a correlation between forced expiratory volume in 1 s (FEV1) and the type of infecting pathogen and that purulence of sputum is one of the most important factors associated with the presence of a bacterial infection. Antibiotics are recommended for patients with exacerbations and sputum purulence. However, resistance to antibiotics is increasing, especially in southern Europe. To reduce the risk of resistance, shorter treatment periods can be implemented for patients with mild-to-moderate exacerbations.

COPD guidelines in relation to infections: a critical analysis