Evidence-based approach to acute exacerbations of XXXX .

@entity1 @entity230 @entity558 @entity712 @entity1353 @entity26 @entity1151 @entity281 @entity1030 @entity2263 @entity204
@entity1030 ( @entity1030 ) is the fourth leading cause of @entity204 in the United States, and it accounts for approximately 500,000 hospitalizations for exacerbations each year. New definitions of acute @entity1030 have been suggested, but the one used by Anthonisen et al. is still widely accepted. It requires the presence of one or more of the following findings: increase in sputum purulence, increase in sputum volume, and worsening of @entity1353 . @entity1 with @entity1030 typically present with acute decompensation of their disease one to three times a year, and 3% to 16% of these will require hospital admission. Hospital mortality of these admissions ranges from 3% to 10% in severe @entity1030 @entity1 , and it is much higher for @entity1 requiring ICU admission. The etiology of the exacerbations is mainly infectious (up to 80%). Other conditions such as @entity712 , @entity1151 , @entity281 , and pneumothorax can mimic an acute exacerbation or possibly act as "triggers." Baseline chest radiography and arterial blood gas analysis during an exacerbation are recommended. @entity26 administration through a venturi mask seems to be appropriate and safe, and the @entity26 saturation should be kept just above 90%. Either a short acting @entity2263 -agonist or an anticholinergic is the preferred bronchodilator agent. The choice between the two depends largely on potential undesirable side effects and the @entity1 's @entity558 . Adding a second bronchodilator to the first one does not seem to offer much benefit. The evidence suggests similar benefit of MDIs when compared with nebulized treatment for bronchodilator delivery. If MDIs are to be used, spacer devices are recommended. @entity230 do improve several outcomes during an acute @entity1030 , and a 10- to 14-day course seems appropriate. Antibiotic use has been shown to be beneficial, especially for @entity1 with severe exacerbation. Changes in bacteria strains have been documented during exacerbations, and newer generations of antibiotics might offer a better response rate. There is no role for mucolytic agents or chest physiotherapy in the acute exacerbation setting. Noninvasive positive pressure ventilation might benefit a group of @entity1 with rapid decline in respiratory function and gas exchange. It has the potential to decrease the need for intubation and invasive mechanical ventilation and possibly decrease in-hospital mortality.
