Patients with chronic obstructive pulmonary disease have exacerbationscharacterized by increased dyspnea, accompanied by increasesin coughing, sputum production and purulence, and wheezing.Although most of these episodes are self-limited, they are associatedwith substantial decrements in the quality of life1 and accountfor a large fraction of expenditures for the treatment of chronicobstructive pulmonary disease, since exacerbations are the mostcommon cause of hospitalization among patients with this disease.The precise nature of these episodes is not well understood;their characteristics suggest that they are acute infectionsof the intrapulmonary airways, but this is extremely difficultto demonstrate . . . [Full Text of this Article]
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