What is the treatment for Chronic Obstructive Pulmonary Disease (COPD) exacerbation?

From the Guidelines

Treatment for COPD exacerbation should involve a multi-faceted approach focusing on bronchodilation, reducing inflammation, and supporting respiratory function, with short-acting bronchodilators, systemic corticosteroids, and antibiotics as needed, as recommended by the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1. The cornerstone of treatment includes short-acting bronchodilators such as albuterol (2-4 puffs every 4-6 hours) or ipratropium (2 puffs every 6 hours), which can be delivered via nebulizer or metered-dose inhaler with a spacer.

Key Treatment Components

• Systemic corticosteroids are essential, typically prednisone 40mg daily for 5 days, as they shorten recovery time and improve FEV1, oxygenation, and reduce the risk of early relapse, treatment failure, and hospitalization duration 1.
• For patients with signs of infection (increased sputum purulence, fever), antibiotics are recommended, with options including azithromycin 500mg on day 1 followed by 250mg daily for 4 days, amoxicillin-clavulanate 875/125mg twice daily for 5-7 days, or doxycycline 100mg twice daily for 5-7 days.
• Supplemental oxygen should be provided to maintain oxygen saturation at 88-92%.
• For severe exacerbations, non-invasive positive pressure ventilation (NIPPV) may be necessary, as recommended by the European Respiratory Society/American Thoracic Society guideline 1.

Post-Acute Phase Management

After the acute phase, patients should transition to maintenance therapy with long-acting bronchodilators and possibly inhaled corticosteroids, to prevent further deterioration of lung function during an exacerbation.

Additional Considerations

• Methylxanthines are not recommended due to side effects 1.
• NIV should be the first mode of ventilation used to treat acute respiratory failure 1.
• Appropriate measures for exacerbation prevention should be initiated after an exacerbation 1.

From the FDA Drug Label

Wixela Inhub® 250/50 is also indicated to reduce exacerbations of COPD in patients with a history of exacerbations The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily, approximately 12 hours apart. If shortness of breath occurs in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief

COPD Exacerbation Treatment: Salmeterol (INH) is indicated to reduce exacerbations of COPD in patients with a history of exacerbations. The recommended dosage for patients with COPD is 1 inhalation of Wixela Inhub® 250/50 twice daily. For immediate relief of shortness of breath, an inhaled, short-acting beta2-agonist should be taken. 2

From the Research

COPD Exacerbation Treatment

• The treatment of COPD exacerbations typically involves the use of systemic corticosteroids, bronchodilators, and antibiotics 3.
• A study comparing short-duration (seven or fewer days) and conventional longer-duration (longer than seven days) systemic corticosteroid treatment found no difference in risk of treatment failure or relapse between the two groups 3.
• Another study compared the efficacy and safety of long-acting anticholinergic and a combination of inhaled steroids and long-acting beta-2 agonist in moderate chronic obstructive pulmonary disease, and found that both treatments provided similar improvements in pulmonary function tests, patient-reported outcomes, and exercise capacity 4.

Medications Used in COPD Exacerbation Treatment

• Bronchodilators, such as beta-agonists and anticholinergics, are commonly used in the treatment of COPD exacerbations 5, 6.
• Inhaled corticosteroids may also be used in combination with bronchodilators to reduce inflammation and improve symptoms 7.
• A study comparing inhaled corticosteroids and long-acting beta(2)-agonists found that both treatments conferred similar benefits, but inhaled corticosteroids increased the risk of pneumonia 7.

Treatment Duration and Outcomes

• A study found that five days of oral corticosteroids was likely sufficient for treatment of adults with acute exacerbations of COPD, and that shorter courses of systemic corticosteroids did not lead to worse outcomes than longer courses 3.
• Another study found that the time to the first exacerbation did not differ between patients treated with salmeterol/fluticasone combination and those treated with tiotropium 4.
• A review of clinical trials found that anticholinergic use was associated with a 30% reduction in COPD hospitalizations and a 70% reduction in respiratory mortality, while beta-agonist use had no effect on COPD hospitalizations and was associated with a two-fold increased risk for respiratory death 5.