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COPD exacerbation was defined as the appearance or worsening of at least two major symptoms (cough, expectoration, purulent sputum, wheezing, or dyspnoea) persisting for at least 48 h following exclusion of cardiac insufficiency, pulmonary embolism, pneumothorax, pleural effusion, or cardiac arrhythmia has been ruled out 9,29,30

And its connection to UTIs is more direct than most people realize

The review found that adverse events were relatively uncommon