Causes
As the lungs tend to be vulnerable organs due to their exposure to harmful particles in the air, several things can cause an acute exacerbation of COPD:

Respiratory infection, being responsible for approximately half of COPD exacerbations. Approximately half of these are due to viral infections and another half appears to be caused by bacterial infections. Common bacterial pathogens of acute exacerbations include Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Less common bacterial pathogens include Chlamydia pneumoniae and MRSA. Pathogens seen more frequently in patients with impaired lung function (FEV<35% of predicted) include Haemophilus parainfluenzae (after repeated use of antibiotics), Mycoplasma pneumoniae and gram-negative,  opportunistic pathogens like Pseudomonas aeruginosa and Klebsiella pneumoniae. Allergens, e.g., pollens, wood or cigarette smoke, pollution
Toxins, including a variety of different chemicals
Air pollution
Failing to follow a drug therapy program, e.g. improper use of an inhalerIn one-third of all COPD exacerbation cases, the cause cannot be identified. Diagnosis
The diagnostic criteria for acute exacerbation of COPD generally include a production of sputum that is purulent and may be thicker than usual, but without evidence of pneumonia (which involves mainly the alveoli rather than the bronchi). Also, diagnostic criteria may include an increase in frequency and severity of coughing, as well as increased shortness of breath.A chest X-ray is usually performed on people with fever and, especially, hemoptysis (blood in the sputum), to rule out pneumonia and get information on the severity of the exacerbation.
Theophylline is generally not recommended.There should also be a "care plan" in case of future exacerbations. Patients may watch for symptoms, such as shortness of breath, change in character or amount of mucus, and start self-treatment as discussed with a health care provider. This allows for treatment right away until a doctor can be seen.The symptoms of acute exacerbations are treated using short-acting bronchodilators. A course of corticosteroids, usually in tablet or intravenous rather than inhaled form, can speed up recovery. The IV and oral forms of steroids have been found to be equivalent. Antibiotics are often used but will only help if the exacerbation is due to an infection. Antibiotics are indicated when a patient notes increased sputum production, purulent sputum, increased dyspnea, has an elevated white count, or is febrile. Examples of first-line antibiotics are amoxicillin, doxycycline, and co-trimoxazole. Mechanical ventilation
Severe exacerbations can require hospital care where treatments such as oxygen and mechanical ventilation may be required. Mechanical ventilation can be invasive (endotracheal intubation) or non-invasive forms of ventilation such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP). Epidemiology
The incidence varies depending on which definition is used, but definitions by Anthonisen et al. the typical COPD patient averages two to three AECB episodes per year. With a COPD prevalence of more than 12 million (possibly 24 million including undiagnosed ones) in the United States, there are at least 30 million incidences of AECB annually in the US. References


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