Which of the following is considered first-line therapy for COPD exacerbation?

• A. Systemic corticosteroids
• B. Oxygen therapy alone
• C. Inhaled antibiotics
• D. Bronchodilators alone

Answer: (A)

Systemic corticosteroids target the inflammatory surge driving a COPD exacerbation, speeding up symptom relief, improving lung function, and shortening the illness course with a short, typically 5-day, course. This broad anti-inflammatory effect makes them the best first-line therapy, usually given alongside inhaled bronchodilators to provide immediate relief. Oxygen therapy is crucial if there is hypoxemia, but it does not address the underlying inflammation and therefore isn’t the sole first-line choice for all exacerbations. Inhaled antibiotics are not routinely used unless there is clear evidence of bacterial infection, and bronchodilators alone relieve symptoms without addressing the inflammatory process.