From the Guidelines
Treatment of COPD exacerbation should involve a multi-faceted approach focusing on bronchodilation, anti-inflammation, and supportive care, 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 (2.5-5 mg via nebulizer or 4-8 puffs via MDI every 4-6 hours) and ipratropium (0.5 mg via nebulizer or 4-8 puffs via MDI every 4-6 hours).
Key Components of Treatment
- Systemic corticosteroids, typically prednisone 40 mg daily for 5 days, are essential to improve lung function, oxygenation, and shorten recovery time and hospitalization duration 1.
- Antibiotics should be added if there are signs of infection, with options including amoxicillin-clavulanate 875/125 mg twice daily, azithromycin 500 mg on day 1 then 250 mg daily for 4 days, or doxycycline 100 mg twice daily for 5-7 days 1.
- 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 it improves gas exchange, reduces work of breathing and the need for intubation, decreases hospitalization duration, and improves survival 1.
Hospitalization and Maintenance Therapy
- Patients should be assessed for hospitalization based on severity, with ICU admission considered for respiratory failure.
- After the acute phase, maintenance therapy should be optimized with long-acting bronchodilators and inhaled corticosteroids as appropriate, to prevent subsequent events and minimize the negative impact of the current 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
The treatment of COPD exacerbation involves the use of Wixela Inhub 250/50 to reduce exacerbations in patients with a history of exacerbations, with a recommended dosage of 1 inhalation twice daily. For immediate relief of shortness of breath, an inhaled short-acting beta2-agonist should be used 2.
From the Research
Treatment of COPD Exacerbation
- The treatment of COPD exacerbation typically involves a combination of bronchodilators, corticosteroids, and antibiotics 3.
- Targeted O2 therapy is also important and should be titrated to an SpO2 of 88-92% 4.
- Noninvasive ventilation (NIV) is a standard therapy for patients with COPD exacerbation and is supported by clinical practice guidelines 4.
- Inhaled short-acting bronchodilators can be provided by nebulizer, pressurized metered-dose inhaler, or dry powder inhaler 4.
Pharmacological Management
- Bronchodilators are the cornerstone of COPD management, with short-acting bronchodilators used as rescue medication and long-acting bronchodilators or long-acting muscarinic agents used for patients in groups B, C, and D 5.
- Inhaled corticosteroids are only recommended for patients in groups C and D 5.
- Combination therapy with a short-acting anticholinergic and a long-acting beta-agonist, or a long-acting anticholinergic and a short- or long-acting beta-agonist, has been shown to improve lung function versus monotherapy 6.
Prevention and Disease Impact
- Preventing early recurrence and readmission to hospital is important, and interventions such as antibiotics or anti-inflammatories may be beneficial in this period 7.
- Domiciliary NIV and pulmonary rehabilitation can have a positive impact on patients with COPD exacerbation 7.
- Dual bronchodilators can reduce exacerbation frequency, and triple therapy should be considered in patients with continuing exacerbations, especially if blood eosinophils are elevated 7.