are the bacteria that most frequently cause exacerbations of COPD. However, the choice of antibiotics must be based on the antibiogram (GICOPD 2001). Hospital treatment The criteria for necessary hospital treatment, whether during admission to the emergency department, or during hospitalization, for exacerbations of COPD are described in the GOLD guidelines (GICOPD 2001). Hospital treatment is increasingly focused on the management of lung function and associated complications, particularly consider- ing the increased number of early discharges (MacNee and Calverley 2003). Firstly, it is necessary to establish whether the exacerbation of COPD may be life-threaten- ing and if this is the case the patients must be admitted to intensive care. The risk of mortality from exacerbations of COPD is connected with the level of respiratory acidosis, the presence of concomitant diseases, and the need for assisted ventilation (Connors et al 1996). In the absence Pharmacological treatment of COPD of these characteristics, the risk of mortality is low, even though patients with severe COPD require hospitalization (GICOPD 2001). In these cases the effectiveness of home treatment is poor (Shepperd, Harwood, Gray, et al 1998). However, the results are better if home treatment follows a careful assessment in the emergency department and is combined with adequate doctor- or nurse-administered home care (Gravil et al 1998). Controlled oxygen therapy is the cornerstone of hospital treatment of exacerbations of COPD (GICOPD 2001). It is relatively easy to achieve adequate oxygenation (PaO2 > 60 mmHg or SaO2 > 90%) in uncomplicated exacerbations, but CO2 retention can occur (GICOPD 2001). β2-agonists are the main bronchodilators used for the treatment of exacerbations of COPD (Siafakas et al 1995; Celli 1996; BTS 1997). If rapid bronchodilation does not occur with these drugs, an antimuscarinic agent may be administered, even if the effectiveness of this combination is controversial (Fernandez et al 1994; Moayyedi et al 1995). The role of theophylline in the treatment of exacerbations of Start or increase treatment with bronchodilators, consider antibiotics Re-evaluate after several hours Resolution or improvement of symptoms Continue the treatment, with reduction if possible Review the chronic treatment No improvement or resolution Oral glucocorticoids Re-evaluate after several hours Worsening of symptoms Admission to hospital Figure 3 Algorithm for the home treatment of an exacerbation of COPD (adapted from Global Initiative for Chronic Obstructive Lung Disease. 2001. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. National Institutes of Health. National Heart, Lung, and Blood Institute. Publication number 2701). International Journal of COPD 2006:1(4) 419