initial management of exacerbation of COPD

Last edited 12/2018

Exacerbations of COPD are associated with increased:

• dyspnoea
• sputum purulence
• volume of sputum

Initial management of an exacerbation of COPD:

• increase frequency of bronchodilator use - consider giving via a nebuliser
• oral antibiotics if purulent sputum
• prednisolone 30 mg daily for 7-14 days -for all patients with significant increase in breathlessness, and all patients admitted to hospital, unless contraindicated

Various factors are considered when deciding whether the patient should be managed in the community or in the hospital (1).

• factors which favour treatment in hospital
  
  
  • not able to cope at home
    
    
  • severe beathlessness
    
    
  • general condition is poor/ deteriorating
    
    
  • level of activity is poor/confined to bed
    
    
  • cyanosis is present
    
    
  • worsening peripheral oedema
    
    
  • impaired level of consciousness
    
    
  • patients is already receiving long term oxygen therapy
    
    
  • patient is living alone/ not coping
    
    
  • acute confusion is present
    
    
  • exacerbation has had a rapid rate of onset
    
    
  • there is significant comorbidity particularly cardiac disease and insulin-dependent diabetes)
    
    
  • SaO2 < 90%
    
    
  • changes on the chest radiograph are present
    
    
  • arterial pH level < 7.35
    
    
  • arterial PaO2 < 7 kPa

For further details the consult the full guideline (1).

Reference:

1. NICE (2018). Chronic obstructive pulmonary disease - management of chronic obstructive pulmonary disease in adults in primary care and secondary care