Selecting a Treatment Regimen
Management Scheme for Patients With Mild to Moderate Exacerbations of COPD
Initiate or increase short-acting bronchodilator therapy Consider antibiotics
Reassess within hours
Improvement of signs/symptoms Continue management
Step down when possible Review long-term management No improvement Add oral corticosteroids*
Reassess within hours, exclude complications Worsening of signs/symptoms or failure
Refer to hospital
Management Scheme for Patients With Moderate to Severe Exacerbations of COPD
Assess severity: > Symptoms > Arterial blood gases (ABG) > Chest X-ray
Controlled oxygen therapy: Repeat ABG measurement aſter 60 min of starting
Bronchodilators: > Increase doses or frequency > Combine short-acting -agonists and
β2
> Use spacers or air-driven nebulizers
anticholinergics
> Consider adding IV aminophylline
Add oral or IV corticosteroids*
Consider: > Antibiotics for bacterial infection > Noninvasive mechanical ventilation
At all times: > Monitor fluid balance and nutrition > Consider heparin > Manage comorbidities
* 5-60 mg prednisone or equivalent Adapted from: Rodriguez-Roisin R. COPD exacerbations 5: management. Thorax. 2006;61:535-544.
