Discharge Medication Regimen for AECOPD
Bronchodilator Therapy
- The European Respiratory Society recommends short-acting beta-agonist (SABA) via MDI with spacer as the primary rescue medication, with dosing of 2 puffs every 2-4 hours as needed 1
- Consider adding ipratropium bromide MDI for patients with more severe symptoms or those who had poor response to beta-agonist alone during hospitalization, as suggested by the European Respiratory Society 1, 2
- MDI with spacer is as effective as nebulized therapy once the patient is stabilized, and facilitates earlier discharge from hospital, according to the European Respiratory Journal and Thorax 3, 4
- Ensure proper MDI technique is taught and demonstrated by the patient before discharge, as recommended by the European Respiratory Journal 5
Corticosteroid Considerations
- The European Respiratory Society recommends continuing oral prednisone 30-40 mg daily to complete a 10-14 day course if the patient received systemic corticosteroids during treatment 1, 2
- Consider adding inhaled corticosteroids by MDI for patients with frequent exacerbations, as suggested by the European Respiratory Society 1
Antibiotic Therapy
- The American Thoracic Society recommends ensuring the patient completes the full 5-7 day course of antibiotics if started during treatment for purulent sputum or increased sputum volume 6
- Common antibiotics such as amoxicillin, tetracycline, or amoxicillin/clavulanate are usually sufficient unless there was poor response, according to Thorax 7, 8
Important Discharge Considerations
- Ensure the patient understands how to use the MDI with spacer correctly, with technique taught and verified before discharge, as recommended by the European Respiratory Journal 5
- Transition from nebulizer to MDI should occur at least 24 hours prior to discharge to ensure stability on the discharge regimen, according to Thorax 3
- Schedule follow-up within 30 days of discharge to reduce risk of readmission, as recommended by the American Journal of Respiratory and Critical Care Medicine 6