Severe chronic obstructive pulmonary disease (COPD) exacerbations requiring hospitalization are a major cause of morbidity and mortality. Recognition of the importance of COPD exacerbations has led to the knowledge that prevention of exacerbations and early treatment are important goals of COPD therapy. Preventive management of COPD aiming at reducing exacerbations complicated by hospital admissions includes vaccination, avoiding pollutant exposure, and, when indicated, long-term oxygen therapy. Landmark studies have shown benefits of long-acting inhaled bronchodilators and combined long-acting inhaled bronchodilators with corticosteroids. The combination of a long-acting muscarinic antagonist with a long-acting beta (2) agonist and inhaled corticosteroids offers the best possibility to reduce the risk of exacerbations requiring hospital admissions. Pulmonary rehabilitation in COPD patients at risk of being hospitalized and regular physical activity have been shown to be associated with a lower risk of hospital admissions. Recent advances in the delivery of evidence-based care including a collaborative multicomponent self-management intervention can reduce the risk of COPD hospital admissions. If physicians meet best practice, this will have potential clinical implications, including a reduction of hospitalizations. Novel pharmacological therapy, which can prevent disease progression and exacerbations, is still needed. New self-management strategies such as a written action plan that helps patients recognize their exacerbation and promptly access treatment may have great potential. This needs to be evaluated in a properly designed randomized clinical trial before it becomes the standard of care for COPD patients.
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