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7 Appropriate exacerbation management, prevention and early intervention are the goals for COPD treatment. 4, 5 Exacerbations are also associated with poor quality of life 6 and earlier recognition and intervention in exacerbations could improve outcomes and result in a better quality of life. There is also some evidence to suggest that those patients with more frequent exacerbations tend to have a more rapid decline in lung function and clear evidence that patients with lower FEV 1 tend to have more exacerbations. Disease progression is also characterized by an increasing frequency of exacerbations and these exacerbations are associated with significant morbidity, mortality and increased healthcare utilization. However, it is well recognized that FEV 1 alone does not fully characterize the disease and that there are many phenotypes and extra-pulmonary comorbidities. Disease progression is usually defined by progressive worsening of airflow obstruction or the rate of decline in forced expiratory volume in 1 second (FEV 1). Chronic Obstructive Pulmonary Disease (COPD) is a major health problem and a leading cause of disability and mortality throughout the world.1– 3 The disease is characterized by chronic airway inflammation and airflow obstruction that is partially reversible on administration of inhaled bronchodilator therapy.

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