Table 1

 What is known of pharmacological treatment

FEV1, forced expiratory volume in 1 second; Pao2, arterial oxygen pressure.
Bronchodilators
Short acting inhaled bronchodilators
• Improve symptoms and FEV1
• No differences between different classes
• No additional benefit with combinations
• No differences between MDI and nebuliser use
• Recommend increasing dose and/or frequency of existing classes
Theophylline
• Discrete effects on symptoms and lung function (second line treatment)
• Numerous side effects
Systemic corticosteroids
• Improve symptoms, FEV1 and Pao2 in moderate to severe exacerbations
• Reduce treatment failure, relapse and length of hospital stay
• Induce more side effects (such as hyperglycaemia)
Antibiotics
• Less risk of treatment failure, mortality and sputum purulence in moderate to severe exacerbations
• Oral route is preferred and cheaper
• Unlikely benefit of short courses of antibiotics in most patients