COPD Exacerbation
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Chronic Obstructive Pulmonary Disease (COPD) exacerbation is a worsening or “flares up” of your COPD symptoms, commonly caused by infection in the lungs but in some cases the cause is unknown.
Clinical presentation
- Worsening of cough,
- Increase in phlegm production,
- Change in phlegm quality, and increase in dyspnea
Table 9.11: COPD Exacerbation Management
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AGENT |
DOSE |
|
SAMA S: ipratropium bromide (aeresol) |
MDI 4-8 puffs every 1-2 hours Nebulizer 0.5mg every 1-2hours |
|
SABA A: salbutamol (inhalation) |
MDI 4-8 puffs every 1-2hours Nebulizer 2.5-5mg every 1-2hours |
|
Corticosteroids A: prednisone (PO) If severe: A: hydrocortisone (IV) D: methylprednisolone (IV) |
40mg AM for 5days 1-2mg/kg 6hourly 125mg 6hourly for 72hours (Then switch oral) |
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Antibiotic (If infection Presents) (Penicillin/Macrolide/Fluoroquinolone) |
|
|
A: amoxicillin (PO) |
500mg 8hourly for 7days |
|
OR |
|
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A: ciprofloxacin (PO) |
500mg 12hourly for 7days |
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OR |
|
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A: doxycycline (PO) |
100mg every 12hrs 7days |
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OR |
|
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C: clarithromycin (PO) |
500mg 12hourly for 7days |
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If possible, do culture and sensitivity |
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Noninvasive positive pressure ventilation |
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Oxygenation if indicated |
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