Severe acute exacerbations of chronic obstructive pulmonary disease (COPD) are devastating, life-threatening events; the 30-day mortality is greater than that with acute myocardial infarction (26% vs. 7.8%).1,2 Acute exacerbations of COPD dramatically change the course of the disease, since they are associated with a rapid decline in lung function and worsening quality of life.3 They also represent a substantial economic burden to society.3 Prevention of exacerbations remains a primary goal of management3 but is difficult because the cause of acute exacerbations of COPD remains largely unknown.4
Recent studies have shown that, when used properly, inhaled glucocorticoids, long-acting beta2 . . .
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