From the Guidelines
Bronchitis and COPD exacerbations should be treated with a combination of bronchodilators, corticosteroids, and antibiotics when appropriate, with the goal of minimizing morbidity, mortality, and improving quality of life. For acute exacerbations, short-acting bronchodilators like albuterol (2-4 puffs every 4-6 hours) via inhaler or nebulizer are the first-line treatment to relieve airway constriction, as recommended by the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1.
Treatment Approach
- Oral corticosteroids such as prednisone (40mg daily for 5-7 days) help reduce inflammation, with evidence suggesting that systemic glucocorticoids shorten recovery time and improve FEV1 1.
- Antibiotics are added when there are signs of bacterial infection, with common options including azithromycin, amoxicillin-clavulanate, or doxycycline, as indicated in the management of COPD exacerbations guideline 1.
- Oxygen therapy is necessary if oxygen saturation falls below 88-90%.
- For ongoing management, long-acting bronchodilators like tiotropium or salmeterol are recommended, sometimes combined with inhaled corticosteroids.
Supportive Measures
- Pulmonary rehabilitation, smoking cessation, and vaccination against influenza and pneumococcal disease are crucial supportive measures, as suggested by the European Respiratory Society/American Thoracic Society guideline 1.
- Noninvasive mechanical ventilation is recommended for patients with acute or acute-on-chronic respiratory failure, as it improves gas exchange, reduces work of breathing, and decreases hospitalization duration 1.
Key Considerations
- The treatment approach should be individualized based on the patient's severity of symptoms, medical history, and response to treatment.
- Regular follow-up and monitoring are essential to prevent future exacerbations and improve quality of life, as emphasized in the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1.
From the FDA Drug Label
Adult PatientsAcute Bacterial Exacerbations of Chronic Obstructive Pulmonary Disease In a randomized, double-blind controlled clinical trial of acute exacerbation of chronic bronchitis (AECB), azithromycin (500 mg once daily for 3 days) was compared with clarithromycin (500 mg twice daily for 10 days). The primary endpoint of this trial was the clinical cure rate at Day 21 to 24 For the 304 patients analyzed in the modified intent to treat analysis at the Day 21 to 24 visit, the clinical cure rate for 3 days of azithromycin was 85% (125/147) compared to 82% (129/157) for 10 days of clarithromycin The following outcomes were the clinical cure rates at the Day 21 to 24 visit for the bacteriologically evaluable patients by pathogen: PathogenAzithromycin (3 Days) Clarithromycin (10 Days) S. pneumoniae29/32 (91%)21/27 (78%) H. influenzae12/14 (86%)14/16 (88%) M catarrhalis11/12 (92%)12/15 (80%)
The clinical cure rate for azithromycin in the treatment of acute bacterial exacerbations of chronic obstructive pulmonary disease (COPD) was 85% at Day 21 to 24. The most common pathogens were S. pneumoniae, H. influenzae, and M. catarrhalis, with clinical cure rates of 91%, 86%, and 92% respectively for azithromycin 2.
From the Research
Bronchitis and COPD Exacerbation
- COPD exacerbation is characterized by an increase in symptoms such as dyspnea, cough, and sputum production that worsens over a period of 2 weeks 3
- Targeted O2 therapy improves outcomes and should be titrated to an SpO2 of 88-92% in patients with COPD exacerbation 3
- Inhaled short-acting bronchodilators can be provided by nebulizer, pressurized metered-dose inhaler, or dry powder inhaler 3
Treatment Options
- Short-acting inhaled bronchodilators, such as salbutamol and ipratropium bromide, have proven useful in acute exacerbation of COPD 4
- Corticosteroids should be used, either in the outpatient or inpatient setting, with a duration of treatment not exceeding 2 weeks 4
- A combination of ipratropium bromide and albuterol sulfate is more effective than albuterol base alone in improving pulmonary function in patients with COPD 5
- Noninvasive ventilation is standard therapy for patients who present with COPD exacerbation and is supported by clinical practice guidelines 3
Management Strategies
- Effective management of COPD exacerbations is essential to prevent complications and improve patient outcomes 6
- Management strategies include inhaled bronchodilators, systemic steroids, antibiotics, invasive and non-invasive ventilation, oxygen therapy, and pulmonary rehabilitation 6
- Care coordination can improve the effectiveness of care for patients with COPD exacerbation 3
- Evidence-based practices improve outcomes in patients with COPD exacerbation 3