Management of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)
Assessment and Diagnosis
- AECOPD presents as worsening of previous stable situation with increased sputum purulence, increased sputum volume, increased dyspnea, increased wheeze, chest tightness, and/or fluid retention 1
- Consider differential diagnoses including pneumonia, pneumothorax, left ventricular failure, pulmonary embolus, lung cancer, and upper airway obstruction 1
- Determine severity of exacerbation to guide treatment setting (home vs. hospital) 3
Treatment Approach
Bronchodilator Therapy
- Add or increase short-acting bronchodilators as first-line treatment 1, 4
- Use beta-agonists (salbutamol 2.5-5 mg or terbutaline 5-10 mg) and/or anticholinergic drugs (ipratropium bromide 0.25-0.5 mg) 5, 6
- Prefer inhaled route with appropriate device the patient can use effectively 1
Antibiotic Therapy
- Initiate antibiotics if two or more of the following are present: increased breathlessness, increased sputum volume, or development of purulent sputum 1, 3
- Antibiotics can shorten recovery time and reduce the risk of early relapse, treatment failure, and hospitalization duration 7
- Duration of antibiotic therapy should be 5-7 days 7
Corticosteroid Therapy
- Systemic corticosteroids improve lung function, oxygenation, and shorten recovery time and hospitalization duration 7
- Recommended dose is prednisolone 30-40 mg per day for 5-7 days 1, 7
Oxygen Therapy
- For hospitalized patients, provide controlled oxygen therapy to maintain oxygen saturation 3, 6
- Target oxygen saturation should achieve PaO2 >7.5 kPa without causing respiratory acidosis 6
Management Based on Setting
Home Management
- Goals: treat bacterial infection, remove excess secretions, increase maximum airflow, and improve respiratory muscle strength 3
- Treatment components:
Hospital Management
- Goals: evaluate severity, identify cause, provide controlled oxygenation, and return patient to best previous condition 3
- Additional treatments may include:
Ventilatory Support
- Consider non-invasive positive pressure ventilation (NIPPV) or invasive ventilation for patients with pH <7.26 and rising PaCO2 who fail to respond to supportive treatment 5
- NIPPV has been shown to reduce the need for intubation and length of hospital stay 5
Follow-up Care
- Review after an acute exacerbation to assess response to treatment 1
- Use follow-up visit to help patient plan for future and prevent further exacerbations 1
- Provide advice on smoking cessation, lifestyle, activity levels, weight, and review medication 1