What treatment is needed for a patient hospitalized for Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

For a patient hospitalized for COPD exacerbation, the recommended treatment is oral corticosteroids, nebulized bronchodilators, and antibiotics. This approach is based on the most recent and highest quality evidence from the European Respiratory Society/American Thoracic Society guideline 1. The use of oral corticosteroids, such as prednisone 40mg daily for 5 days, helps reduce airway inflammation and improve outcomes. Nebulized bronchodilators, like albuterol 2.5mg every 4-6 hours and ipratropium 0.5mg every 6-8 hours, provide rapid relief of bronchospasm and improve airflow. Antibiotics, such as azithromycin 500mg on day 1, then 250mg daily for 4 days, are typically included because bacterial infections commonly trigger COPD exacerbations. Key points to consider in the management of COPD exacerbations include:

• The use of systemic corticosteroids to improve lung function and shorten recovery time and hospitalization duration, as recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report 1
• The administration of antibiotics to shorten recovery time and reduce the risk of early relapse, treatment failure, and hospitalization duration, as recommended by the GOLD report 1
• The preference for oral corticosteroids over intravenous corticosteroids in patients with intact gastrointestinal access and function, as suggested by the European Respiratory Society/American Thoracic Society guideline 1
• The importance of supplemental oxygen to maintain oxygen saturation between 88-92% and reduce the risk of hypoxemia. Overall, this comprehensive treatment approach reduces inflammation, improves airflow, addresses infectious triggers, and ultimately shortens hospital stays and reduces readmission rates.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment for COPD

The treatment for a patient hospitalized for Chronic Obstructive Pulmonary Disease (COPD) typically involves a combination of medications.

• The most appropriate treatment option is: Oral corticosteroids, nebulized bronchodilators, antibiotics 2.

Rationale

• A study published in 2002 compared the efficacy of an oral/metered-dose inhaler regimen to an intravenous/nebulizer regimen in patients hospitalized for COPD exacerbations, and found no significant differences in outcomes between the two groups 2.
• Another study published in 2010 reviewed the mechanism of action, clinical efficacy, and safety of albuterol, ipratropium, and combined albuterol-ipratropium therapy for the treatment of COPD, and found that combination therapy provides better improvement in airflow than either component alone 3.
• The American Thoracic Society Clinical Practice Guideline published in 2020 recommends the use of long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy for patients with COPD and dyspnea or exercise intolerance 4.
• Other studies have also shown that combination therapy with ipratropium and albuterol is more effective than either agent alone in patients with COPD 5, 6.