Management of Acute Exacerbation of COPD

Initial Assessment and Monitoring

The European Respiratory Society recommends monitoring oxygen saturation continuously with pulse oximetry 2
Obtain arterial blood gases on arrival and repeat 30-60 minutes after initiating oxygen therapy, as recommended by the European Respiratory Society 2
Check blood gases if clinical deterioration occurs, even if initial PCO2 was normal, according to the European Respiratory Society 2

The European Respiratory Society recommends prescribing controlled oxygen therapy with target saturation of 88-92% 2
Use 24% Venturi mask at 2-3 L/min, nasal cannulae at 1-2 L/min, or 28% Venturi mask at 4 L/min, as recommended by the European Respiratory Society 2
For nebulizer treatments, use compressed air to drive nebulizers if the patient has hypercapnia and/or respiratory acidosis, according to the Thorax journal 1

The Thorax journal recommends ordering short-acting beta-2 agonist (salbutamol 2.5-5 mg or terbutaline 5-10 mg) via nebulizer 1
Add anticholinergic (ipratropium bromide 0.25-0.5 mg) via nebulizer, as recommended by the Thorax journal 1
Administer nebulized bronchodilators every 4-6 hours initially, may be used more frequently if required, according to the Thorax journal 1

The Thorax journal recommends prescribing oral prednisolone 30 mg daily for 5-7 days 1
Plan to discontinue corticosteroids after the acute episode (usually 7-14 days) unless there is a definite indication for long-term treatment, as recommended by the Thorax journal 1

The European Respiratory Journal recommends prescribing antibiotics for patients with increased dyspnea, increased sputum volume, and increased sputum purulence 2
For mild to moderate exacerbations, order one of the following: Amoxicillin/ampicillin, Doxycycline, or Amoxicillin-clavulanate, as recommended by the European Respiratory Journal 2

The Thorax journal recommends considering intravenous methylxanthines (aminophylline 0.5 mg/kg/hour) by continuous infusion if patient is not responding to standard therapy 1
If methylxanthines are used, monitor blood levels daily, as recommended by the Thorax journal 1

The Thorax journal recommends initiating non-invasive ventilation (NIV) if respiratory acidosis persists (pH < 7.26) despite standard medical management 1
The European Respiratory Journal recommends considering high-flow nasal cannula oxygen therapy as an alternative in selected patients 2

The Thorax journal recommends avoiding uncontrolled high-flow oxygen which may worsen hypercapnia 1
Do not continue corticosteroids beyond 7-14 days unless specifically indicated, as recommended by the European Respiratory Society 2
Avoid prolonged courses of antibiotics beyond 7 days, according to the European Respiratory Journal 2
The Thorax journal recommends avoiding using intravenous corticosteroids when oral administration is possible, as IV route has higher risk of adverse effects 1