The use of antibiotic treatment in the management of acute exacerbations is further supported by the work of Anthonisen and colleagues [65], as they found a statistically significant advantage when antibiotic therapy was compared with placebo and suggest that it is favorable where increased dyspnea, sputum production or increased purulence of sputum is present in more severe exacerbations. These results are further supported by Adams and colleagues [64] whose findings suggest that individuals treated with antibiotics had significantly lower relapse rates than those who did not receive antibiotics.