Although 79 percent of patients received antibiotics for at least two days, the timing of treatment was critical to their outcome, the researchers found.

Fewer patients whose antibiotic therapy started in the first two days after hospital admission needed to be put on a mechanical ventilator than patients whose treatment started later (1.07 percent versus 1.8 percent), the team noted.

In addition, fewer of the patients treated early on with antibiotics died (about 1 percent versus close to 1.6 percent for those treated later). Those treated early also had fewer treatment failure (about 9.8 percent versus nearly 12 percent), and a lower rate of hospital readmission for acute exacerbations of COPD (7.9 percent versus about 8.8 percent), the researchers found.

While both groups of patients stayed in the hospital for about the same length of time, the costs for those given antibiotics early was less, the researchers said.

"We need better ways of determining which patients will benefit, but for now all patients with COPD exacerbations bad enough to land them in the hospital should be treated with antibiotics," Rothberg said.

Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said the results "are not surprising."

"It's rather commonplace that a patient with COPD comes in and you are looking for reasons for exacerbation," he said. "These can be inflammation, infection or some environmental problem -- most of the time, of course, you are thinking about infection as the primary reason."

Horovitz said that oftentimes, respiratory infection in COPD patients can be hard to diagnose from an X-ray. The only way to be sure the patient has pneumonia is by a lab test. But often the results are not available for a day or more.

"The way I was trained was to start antibiotics that were broad-spectrum enough that
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