Practice Guidelines

Treatment of Chronic Obstructive Pulmonary Disease Exacerbations: Guidelines from the American Academy of Family Physicians


Am Fam Physician. 2021 Jul ;104(1):100-101.

See the full clinical practice guideline from the AAFP: Pharmacologic Management of COPD Exacerbations: A Clinical Practice Guideline from the AAFP

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Systemic corticosteroids prevent clinical failure in COPD exacerbations. Treatment for 10 days or longer increases adverse effects and may not be more effective than treatment for three to five days.

• Antibiotics for seven days increase clinical cure in COPD exacerbations with an NNT of 7.

• Magnesium, theophyllines, and mucolytics do not improve outcomes in COPD exacerbations, and bronchodilators had no benefit in limited studies.

From the AFP Editors

Approximately 15 million Americans are affected by chronic obstructive pulmonary disease (COPD), with airflow limitations, cough, and shortness of breath. Chronic respiratory diseases, including COPD, are the fourth leading cause of death in the United States. Acute exacerbations of COPD increase mortality and hospital admissions while reducing lung function and quality of life. Despite this risk, evidence is limited for treating exacerbations. The American Academy of Family Physicians (AAFP) has published guidelines for treating acute exacerbations of COPD based on a systematic review.


In acute exacerbations, systemic corticosteroids reduce exacerbations with a number needed to treat (NNT) of 3 to prevent clinical failure. Clinical failure is defined as the lack of significant clinical improvement or the need for additional therapy. This is based on only two randomized controlled trials with 286 patients, yet there were no clinical failures in the corticosteroid group of either study. The evidence is low quality due to the high risk of bias and imprecision in both studies. Adverse events are not significantly increased with corticosteroid therapy. Treatment for 10 to 14 days may not provide greater benefit over treatment for three to five days. A large retrospective study of more than 10,000 patients demonstrated small increases in hospitalization for pneumonia and mortality with longer corticosteroid courses.

Antibiotic Therapy

Antibiotic therapy also improves outcomes in acute

Author disclosure: No relevant financial affiliations.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at



Copyright © 2021 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in Pubmed


Jan 2022

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article