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

From the Guidelines

Treatment for Chronic Obstructive Pulmonary Disease (COPD) Exacerbation

The treatment for 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 shorten recovery time, and antibiotics when indicated to reduce the risk of early relapse and treatment failure 1.

• Bronchodilators: Short-acting inhaled β2-agonists, such as salbutamol or albuterol, with or without short-acting anticholinergics, such as ipratropium, are recommended as the initial treatment for an acute exacerbation of COPD 1.
• Systemic Corticosteroids: These improve lung function, oxygenation, and shorten recovery time and hospitalization duration. The duration of therapy should not exceed 5-7 days 1.
• Antibiotics: When indicated, antibiotics can shorten recovery time and reduce the risk of early relapse, treatment failure, and hospitalization duration. The duration of antibiotic therapy should be 5-7 days 1.
• Noninvasive Ventilation (NIV): NIV should be the first mode of ventilation used in patients with COPD and acute respiratory failure who have no absolute contraindication, as it improves gas exchange, reduces the work of breathing, and the need for intubation, decreases hospitalization duration, and improves survival 1.
• Pulmonary Rehabilitation: Initiation of pulmonary rehabilitation within 3 weeks after hospital discharge is suggested for patients hospitalized with a COPD exacerbation 1.

It is essential to note that methylxanthines are not recommended due to their side effect profiles 1. The treatment approach should be individualized based on the severity of the exacerbation, the patient's overall health status, and the presence of any comorbidities. Regular follow-up and monitoring are crucial to prevent subsequent exacerbations and manage the disease effectively 1.

From the Research

Treatment for COPD Exacerbation

The treatment for Chronic Obstructive Pulmonary Disease (COPD) exacerbation involves a combination of pharmacological and non-pharmacological interventions.

• The initial strategy for reducing exacerbation risk is to maximize bronchodilation using a long-acting muscarinic antagonist (LAMA)/ long-acting β2-agonist (LABA) combination in patients with frequent exacerbations (>1 exacerbation/year) 2.
• For patients who continue to experience exacerbations despite maximal bronchodilation, treatment should be guided by patient phenotype, with options including:
  • Adding inhaled corticosteroids (ICS) to a LABA/LAMA combination for patients with asthma-COPD overlap syndrome or high blood eosinophil counts 2, 3.
  • Using a phosphodiesterase (PDE)-4 inhibitor (roflumilast) or high-dose mucolytic agents for patients with chronic bronchitis 2.
  • Adding mucolytic agents or a macrolide antibiotic (e.g. azithromycin) for patients with frequent bacterial exacerbations and/or bronchiectasis 2.
• Systemic corticosteroids are recommended for the treatment of acute exacerbations of COPD, with low-dose oral corticosteroids being as efficacious as high-dose, intravenous corticosteroid regimens while minimizing adverse effects 4.
• Noninvasive ventilation is indicated in patients with respiratory failure, and pulmonary rehabilitation should be included as part of a comprehensive management plan 2, 5, 3.
• Other aspects of treatment include smoking cessation, vaccination, and treatment of hypoxaemia and hypercapnia to reduce the rate of COPD exacerbations 5, 3.

Pharmacological Treatment

Pharmacological treatment for COPD exacerbation includes:

• β-agonists and anticholinergics as initial treatment 5.
• Systemic corticosteroids to improve airflow, decrease the rate of treatment failure and risk of relapse, and improve symptoms 4.
• Antibiotic therapy for patients with presumed bacterial infection 5.
• Inhaled corticosteroids for patients with elevated peripheral eosinophil levels or asthma-COPD overlap syndrome 3.

Non-Pharmacological Treatment

Non-pharmacological treatment for COPD exacerbation includes:

• Pulmonary rehabilitation to improve symptoms and exercise tolerance 2, 3.
• Supplemental oxygen for patients with resting hypoxemia to improve survival 3.
• Smoking cessation to prevent further COPD exacerbations 5.
• Vaccination to prevent infections that can trigger exacerbations 5, 3.