Primary care management of chronic obstructive pulmonary disease to reduce exacerbations and their consequences

Am J Med Sci. 2010 Oct;340(4):309-18. doi: 10.1097/MAJ.0b013e3181e40cd1.


Exacerbations of chronic obstructive pulmonary disease (COPD)-acute worsenings of dyspnea, cough and/or sputum production beyond daily symptom variations, necessitating a change in treatment-account for most COPD-related morbidity, care burden and direct costs. Frequent exacerbations (especially those requiring emergency, inpatient or intensive care) reduce physical activity, accelerate lung function decline and increase mortality. This review profiles exacerbation diagnosis, treatment and reduction measures for primary care physicians. Chronic maintenance pharmacotherapy is important to reduce exacerbations. Tiotropium, a long-acting anticholinergic, and salmeterol/fluticasone, a long-acting β-agonist/inhaled corticosteroid combination, are Food and Drug Administration-approved maintenance therapies to reduce exacerbations of COPD. Influenza and pneumonia vaccinations reduce infectious triggers; pulmonary rehabilitation reduces exacerbation recurrence. Acute exacerbation treatment (short-acting bronchodilators, systemic corticosteroids and/or antibiotics) should be complemented by long-term COPD maintenance therapy to reduce future exacerbations. Recognition of a COPD exacerbation signals primary care physicians to establish long-term COPD management to reduce morbidity, disability and mortality.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Algorithms
  • Anti-Bacterial Agents / administration & dosage
  • Evidence-Based Medicine
  • Humans
  • Primary Health Care
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Recurrence
  • Respiratory Function Tests
  • Self Care


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents