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Patient Oriented Evidence that Matters

Introduction COPD POEM PDF
The COPDX Plan
Confirm diagnosis & assess severity
Optimise function
Prevent deterioration
Develop support network & self-management plan
eXacerbations manage appropriately
Review of drug use in COPD
Appendix One - Resources and contacts

X eXacerbations - manage appropriately

Management of exacerbations

An exacerbation of COPD is a sustained worsening of symptoms from the usual stable state and is acute in onset. Frequently reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour (NICE, 2004).

A wide range of other comorbidities may confuse the diagnosis of an exacerbation of COPD as they produce similar symptoms. They include:

  • Pneumonia
  • Pneumothorax
  • Left ventricular failure/pulmonary oedema
  • Pulmonary embolus
  • Lung cancer
  • Upper airway obstruction
  • Pleural effusion
  • Recurrent aspiration
  • Arrhythmias

Exacerbations can usually be managed at home unless the exacerbation is severe or of rapid onset, the diagnosis is in doubt, oxygen is needed, or there are other medical or psychosocial reasons for admission.

Treatment options for an exacerbation of COPD managed at home include:

  • For most patients:
    • Increase dose and frequency of inhaled short-acting bronchodilators via spacer.
    • Prednisone 40mg daily by mouth for 7-14 days.
  • For patients with increased or more purulent sputum, in addition to above:
    • Antibiotics: starting usually with amoxicillin 500mg TDS for 7-10 days, or,
      doxycycline 100mg daily for 7-10 days.
      Macrolide antibiotics are often ineffective in bacterial exacerbations of COPD and may also increase theophylline levels.

The earlier an exacerbation is treated the better the results and so most patients who get exacerbations will benefit from having a supply of prednisone and a suitable antibiotic at home.

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