From the Guidelines
The treatment of acute exacerbation of COPD should involve a multi-faceted approach focusing on bronchodilation, anti-inflammatory therapy, and supportive care, with short-acting bronchodilators, systemic corticosteroids, and antibiotics as the cornerstone of treatment, as recommended by the most recent and highest quality study 1.
Key Components of Treatment
- Short-acting bronchodilators, such as albuterol (salbutamol) 2.5-5mg via nebulizer or 4-8 puffs via MDI every 4-6 hours, often combined with ipratropium bromide 0.5mg nebulized or 4-8 puffs via MDI every 4-6 hours, are recommended as the initial bronchodilators to treat an acute exacerbation 1.
- Systemic corticosteroids, such as prednisone 40mg daily for 5 days, improve lung function, oxygenation, and shorten recovery time and hospitalization duration 1.
- Antibiotics, such as amoxicillin-clavulanate 875/125mg twice daily, doxycycline 100mg twice daily, or azithromycin 500mg on day 1 followed by 250mg daily for 4 days, are indicated when there are signs of bacterial infection, and can shorten recovery time and reduce the risk of early relapse, treatment failure, and hospitalization duration 1.
Additional Considerations
- Supplemental oxygen should be titrated to maintain oxygen saturation between 88-92% 1.
- For severe exacerbations, non-invasive positive pressure ventilation (NIPPV) may be necessary to reduce work of breathing and avoid intubation, as it improves gas exchange, reduces work of breathing and the need for intubation, decreases hospitalization duration, and improves survival 1.
- After the acute phase, transitioning to maintenance therapy with long-acting bronchodilators and implementing pulmonary rehabilitation are essential to prevent future exacerbations 1.
From the Research
Acute Exacerbation of COPD Treatment
The treatment of acute exacerbation of COPD (AECOPD) involves a combination of pharmacological and non-pharmacological interventions.
- Short-acting inhaled bronchodilators, such as salbutamol and ipratropium bromide, are useful in the treatment of AECOPD 2.
- Corticosteroids should be used, either in the outpatient or inpatient setting, with a duration of treatment not exceeding 2 weeks 2.
- Antibacterials, especially in patients with purulent or increased sputum, should be used, guided by the local antibiogram of the key microbes 2.
- Controlled oxygen therapy improves outcome in hypoxaemic patients, and arterial blood gases should be performed to ensure hypercarbia is not becoming excessive 2.
- Noninvasive positive pressure ventilation could be used to improve outcomes without resorting to invasive mechanical ventilation 2.
Pharmacological Treatments
Pharmacological treatments for AECOPD include:
- Inhaled bronchodilators, steroids, and antibiotics 3.
- Corticosteroids have strong evidence of their efficacy in the treatment of AECOPD 3, 4.
- Antibiotics are preferred in ICU patients, but there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients 3.
- Azithromycin has been shown to decrease the frequency of exacerbations in patients with COPD who have an increased risk of exacerbations 5.
Non-Pharmacological Treatments
Non-pharmacological treatments for AECOPD include:
- Oxygen therapy, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV), and pulmonary rehabilitation (PR) 3.
- Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety 3.
- Noninvasive ventilation (NIV) can have a positive impact in patients who are persistently hypercapnic following discharge 6.
- Pulmonary rehabilitation can also have a positive impact on patients with COPD 6.