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The impact of risk factors and triggers such as smoking, severe airflow limitation, bronchiectasis, bacterial and viral infections and comorbidities is discussed. More severe exacerbations should be treated with \u03b2-agonists and anticholinergics as well as systemic corticosteroids. Antibiotic therapy should only be given to patients with presumed bacterial infection. Noninvasive ventilation is indicated in patients with respiratory failure. Smoking cessation is key to prevent further COPD exacerbations. Other aspects include choice of pharmacotherapy, including bronchodilators, inhaled corticosteroids, phosphodiesterase-4 inhibitors, long-term antibiotics and mucolytics. Better education and self-management as well as increased physical activity are important. Influenza and pneumococcal vaccination is recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of COPD exacerbations, while most interventional bronchoscopic therapies increase exacerbation risk within the first months after the procedure.<\/jats:p>","DOI":"10.1183\/16000617.0103-2017","type":"journal-article","created":{"date-parts":[[2018,3,14]],"date-time":"2018-03-14T07:20:17Z","timestamp":1521012017000},"page":"170103","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":250,"title":["Exacerbations of COPD"],"prefix":"10.1183","volume":"27","author":[{"given":"Christian","family":"Viniol","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus F.","family":"Vogelmeier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2018,3,14]]},"reference":[{"key":"2024102403324886000_27.147.170103.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61728-0"},{"key":"2024102403324886000_27.147.170103.2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2005.040527"},{"key":"2024102403324886000_27.147.170103.3","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00214-2017"},{"key":"2024102403324886000_27.147.170103.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61380-4"},{"key":"2024102403324886000_27.147.170103.5","unstructured":"Lopez AD , Mathers CD , Ezzati M , et al. 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