Acute exacerbations of obstructive lung disease. What to do when immediate care is crucial.

Obstructive lung disease is a major cause of morbidity and mortality in the United States, and the mortality rate is rising. Successful treatment of acute exacerbations begins with appropriate assessment and intervention. Supplemental oxygen is appropriate for all patients with hypoxemia, and mechanical ventilation should be considered in those with clouded consciousness, profound acidosis, or severe hypoxemia. Inhaled beta 2 agonists are the first line of therapy in acute exacerbations. Anticholinergics, methylxanthines, and corticosteroids may also be useful. Alternative therapies (eg, magnesium, glucagon, calcium channel blockers, clonidine, helium) are receiving increased attention and are undergoing investigation.