 Eligible patients will be identified by research assistants and the attending ED physician will be notified. The attending ED physician will make the final decision regarding severity based on their physical exam and spirometry FEV 1 results. The FEV 1 value will be recorded and calculated as a percentage of their predicted based on standardized height and weight charts. All spirometry will be performed by licensed respiratory therapists or research assistants trained in the use of the spirometer. An FEV 1 of 50 to 70 predicted will be considered a moderate exacerbation and if less than 50 predicted, severe. 