Exacerbations of chronic obstructive pulmonary disease (COPD) involve inflammatory events in the airway caused mostly by infection—bacterial, viral, or both.1 During the last 2 decades, the understanding of exacerbations has improved, and these exacerbations are now regarded as major contributors to cost of care, health status deterioration, loss of lung function, and mortality in COPD.2 However, treatment of exacerbations has not evolved significantly, and clinical failure rates (need for additional treatment or hospitalization) of 20% to 40% within 1 month are still prevalent.3,4
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