COPD exacerbation

COPD exacerbation

Chronic Obstructive Pulmonary Disease (COPD) exacerbation is a worsening or "flare-up" of COPD symptoms, commonly caused by infection in the lungs, although in some cases the cause is unknown.

Clinical presentation

• Worsening of cough

• Increased phlegm production

• Change in phlegm quality

• Increased dyspnoea

COPD exacerbation management

Bronchodilators

Short-acting muscarinic antagonist (SAMA)

Ipratropium bromide (aerosol)

• MDI: 4–8 puffs every 1–2 hours

OR

• Nebulizer: 0.5 mg every 1–2 hours

Short-acting beta-agonist (SABA)

Salbutamol (inhalation)

• MDI: 4–8 puffs every 1–2 hours

OR

• Nebulizer: 2.5–5 mg every 1–2 hours

Corticosteroids

Prednisone (PO)

• 40 mg mane for 5 days

If severe

Hydrocortisone (IV)

• 1–2 mg/kg every 6 hours

Methylprednisolone (IV)

• 125 mg every 6 hours for 72 hours

• Then switch to oral therapy

Antibiotics (if infection is present)

Amoxicillin (PO)

• 500 mg every 8 hours for 7 days

OR

Ciprofloxacin (PO)

• 500 mg every 12 hours for 7 days

OR

Doxycycline (PO)

• 100 mg every 12 hours for 7 days

OR

Clarithromycin (PO)

• 500 mg every 12 hours for 7 days

Non-invasive positive pressure ventilation

• Use when indicated.

Oxygen therapy

• Administer oxygen if indicated.