Exacerbations of Chronic Obstructive Pulmonary Disease

Christine Garvey*, 1, 2, Gabriel Ortiz3
1 Seton Pulmonary and Cardiac Rehabilitation, Daly City, CA, USA
2 Sleep Disorders, Pulmonary Division, University of California, San Francisco, CA, USA
3 Pediatric Pulmonary Services, El Paso, TX, USA

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© Garvey and Ortiz; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Seton Pulmonary & Cardiac Rehabilitation, 1900 Sullivan Ave. Daly City, CA 94015, USA; Tel: (650) 991-6776; Fax: (650) 991-6775; E-mail:


Epidemiologic data indicate that chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Patients with poorly managed COPD are likely to experience exacerbations that require emergency department visits or hospitalization—two important drivers contributing to escalating healthcare resource use and costs associated with the disease. Exacerbations also contribute to worsening lung function and negative outcomes in COPD. The aim of this review is to present the perspective of nurse practitioners and physician assistants in terms of providing the pharmacologic and non-pharmacologic modalities needed to treat current and prevent future exacerbations. Major respiratory guidelines recommend treatment of acute exacerbations with short-acting bronchodilators, oral corticosteroids and antibiotics, as appropriate. Supplementary oxygen and/or ventilatory support may also be beneficial to selected patients. Treatments to minimize the risk of future exacerbations should include maintenance pharmacotherapies, risk-reduction measures (e.g. smoking cessation, influenza and pneumonia vaccinations), pulmonary rehabilitation, self-management support and follow-up care.

Keywords: COPD, exacerbations, follow-up care, nurse practitioner, physician assistant.