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a lot of this falls back to education again and having physicians be well attuned to the risk factors the right age the right smoking history of the right symptoms that a patient may be distribute this demonstrating to lead them to think they have COPD do a spirometry and then go from there with regard to the proper drugs based on the symptoms that are there the exacerbations tend to occur in individuals once they have that first exacerbation we know they're more likely to have the second or third exacerbation we also know that the more severe their airflow obstruction is their higher risk of exacerbation one of the measurements is the FE b1 that measures the amount of error that they can exhale during that for a second the lower that is that puts them into a category where there's a higher rate of exacerbation right now the the guidelines for treating COPD really look at controlling symptoms and controlling exacerbations controlling the symptoms help the patient on a day-to-day basis

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