Key points for the management of exacerbations

Short-acting inhaled β2-agonists, with or without short-acting anticholinergics, are recommended as the initial bronchodilators to treat an acute exacerbation (evidence C)
Systemic corticosteroids improve lung function (FEV1), oxygenation and shorten recovery time and hospitalisation duration. Duration of therapy should not be more than 5–7 days (evidence A).
Antibiotics, when indicated, can shorten recovery time, reduce the risk of early relapse, treatment failure, and hospitalisation duration. Duration of therapy should be 5–7 days (evidence B).
Methylxanthines are not recommended due to increased side effect profiles (evidence B)
NIV should be the first mode of ventilation used in COPD patients with acute respiratory failure who have no absolute contraindication because it improves gas exchange, reduces work of breathing and the need for intubation, decreases hospitalisation duration and improves survival (evidence A)

FEV1: forced expiratory volume in 1 s; NIV: non-invasive ventilation; COPD: chronic obstructive pulmonary disease.