COPD and Asthma Exacerbation Management

Diagnostic Workup and Treatment

The European Respiratory Society recommends obtaining arterial blood gas (ABG), chest X-ray, electrocardiogram, and pulse oximetry immediately for patients presenting with suspected COPD or asthma exacerbation 1, 2
ABG analysis is mandatory to assess PaO2, PaCO2, and pH, guiding oxygen therapy targets and identifying respiratory failure requiring ICU admission 2, 3
The European Respiratory Society suggests targeting PaO2 ≥8 kPa (60 mmHg) or SpO2 88-92% with oxygen therapy, never exceeding SpO2 of 92% in COPD patients 2, 3, 5
The European Respiratory Society recommends administering short-acting β2-agonist (albuterol/salbutamol) AND ipratropium via MDI with spacer, 2 puffs every 2-4 hours 1, 2, 3
The European Respiratory Society suggests giving prednisone 30-40 mg orally daily for 10-14 days for COPD exacerbations 1, 2, 3
The European Respiratory Society recommends prescribing antibiotics if patient has ≥2 of the following: increased breathlessness, increased sputum volume, or purulent sputum 4, 8

The European Respiratory Society recommends admitting patients with inadequate response to outpatient management, worsening hypoxemia or hypercapnia, changes in mental status, inability to eat or sleep, high-risk comorbidities, inadequate home support, or uncertain diagnosis 1, 2
The European Respiratory Society suggests initiating noninvasive positive pressure ventilation (NPPV) if pH <7.35 with hypercapnia 6
The European Respiratory Society recommends providing 25-30 kcal/kg/day to prevent malnutrition common in COPD 5
The European Respiratory Society suggests maintaining K+ >4.0 mEq/L and Mg2+ >2.0 mg/dL for optimal respiratory muscle function 5

The European Respiratory Society recommends discharging patients when they are stable on MDI therapy, have SpO2 ≥90% on room air or baseline oxygen requirement, can eat, sleep, and ambulate without severe dyspnea, demonstrate proper MDI technique, and have adequate home support and follow-up arranged 8, 6, 7
The European Respiratory Society suggests prescribing short-acting β2-agonist (albuterol) MDI with spacer, ipratropium bromide MDI, prednisone 30-40 mg daily, antibiotics, and inhaled corticosteroids at discharge 7
The European Respiratory Society recommends scheduling follow-up within 30 days to reduce readmission risk 8, 6, 7