From the Guidelines
The treatment plan for suspected Chronic Obstructive Pulmonary Disease (COPD) exacerbation should include short-acting inhaled β2-agonists, with or without short-acting anticholinergics, as the initial bronchodilators, along with systemic corticosteroids to improve lung function and oxygenation, and antibiotics when indicated, to shorten recovery time and reduce the risk of early relapse 1.
Key Components of Treatment
- Bronchodilators: Short-acting inhaled β2-agonists, with or without short-acting anticholinergics, are recommended as the initial bronchodilators to treat an acute exacerbation 1.
- Systemic Corticosteroids: Improve lung function (FEV1) and oxygenation, and shorten recovery time and hospitalization duration, with a recommended duration of therapy not exceeding 5-7 days 1.
- Antibiotics: When indicated, can shorten recovery time and reduce the risk of early relapse, treatment failure, and hospitalization duration, with a recommended duration of therapy of 5-7 days 1.
- Noninvasive Ventilation (NIV): Should be the first mode of ventilation used in patients with COPD with acute respiratory failure who have no absolute contraindication 1.
Additional Considerations
- Maintenance Therapy: Long-acting bronchodilators should be initiated as soon as possible before hospital discharge 1.
- Pulmonary Rehabilitation: Should be initiated within 3 weeks after hospital discharge for patients hospitalized with a COPD exacerbation 1.
- Home-Based Management: A home-based management program (hospital-at-home) may be suggested for patients with a COPD exacerbation who present to the emergency department or hospital 1.
From the Research
Treatment Plan for Suspected COPD Exacerbation
The treatment plan for suspected Chronic Obstructive Pulmonary Disease (COPD) exacerbation involves a combination of pharmacological and non-pharmacological interventions.
- The goals of treatment are to improve quality of life, reduce exacerbations, and decrease mortality 2.
- Initial pharmaceutical treatment is based on disease severity, with options including:
- Long-acting muscarinic antagonists for mild symptoms 2.
- Dual therapy with a long-acting muscarinic antagonist/long-acting beta2 agonist combination for uncontrolled symptoms 2.
- Triple therapy with a long-acting muscarinic antagonist/long-acting beta2 agonist/inhaled corticosteroid combination for improved symptoms and lung function, although this increases pneumonia risk 2.
- Non-pharmacological interventions include:
- Pulmonary rehabilitation, which improves lung function, increases patients' sense of control, and reduces exacerbations and hospitalizations 3, 4, 2.
- Long-term oxygen therapy, which improves mortality in patients with severe resting hypoxemia or moderate resting hypoxemia with signs of tissue hypoxia 3, 2.
- Supplemental oxygen for patients with resting hypoxemia, which prolongs life 3.
- Other treatments that may be considered include:
- Phosphodiesterase-4 inhibitors and prophylactic antibiotics, which can improve outcomes in some patients 2, 5.
- Lung volume reduction surgery, which reduces symptoms and improves survival in patients with severe COPD 2.
- Lung transplant, which improves quality of life but does not improve long-term survival 2.
- Patients with acute exacerbations may benefit from the addition of inhaled corticosteroids, particularly those with elevated peripheral eosinophil levels 3.