A systematic review has indicated that acute bacterial exacerbations of COPD are common, costly and difficult to manage [59]. A number of researchers have linked AECOPD to bacterial infection by pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa and M. catarrhalis, these bacteria may be associated with increased sputum volume and purulence [59-63]. Antibiotics are often prescribed to alleviate and treat the cough and increased purulent sputum production that leads to increased breathlessness, and in these instances, the use of antibiotics is controversial [59, 62, 64-66]. More recently, it has been suggested that there is an increased recognition that exacerbations may be due to viral infections of the upper respiratory tract so antibiotic treatment may not always be warranted