What is the standard of care for Chronic Obstructive Pulmonary Disease (COPD) exacerbation with increased coughing?

From the Guidelines

The standard of care for COPD exacerbation with increased coughing involves a short course of oral corticosteroids, such as prednisone 40mg daily for 5 days, as suggested by the European Respiratory Society/American Thoracic Society guideline 1. This approach is based on the most recent and highest quality evidence available. The treatment typically begins with short-acting bronchodilators such as albuterol (2-4 puffs every 4-6 hours) and ipratropium (2 puffs every 6 hours) to provide immediate relief of bronchospasm. Key components of the treatment plan include:

• Systemic corticosteroids to reduce airway inflammation
• Antibiotics if there are signs of infection, with common options including azithromycin 500mg on day 1 followed by 250mg daily for 4 days, or doxycycline 100mg twice daily for 5-7 days
• Supplemental oxygen to maintain oxygen saturation above 88-92%
• Increased fluid intake to thin secretions, making coughing more productive
• Airway clearance techniques to help clear secretions For severe exacerbations, hospitalization may be necessary for more intensive treatment, including nebulized bronchodilators, intravenous steroids, and potentially non-invasive ventilation, as recommended by the European Respiratory Society/American Thoracic Society guideline 1. It is essential to note that the American College of Chest Physicians and Canadian Thoracic Society guideline also suggests the use of systemic corticosteroids to prevent hospitalization for subsequent acute exacerbations of COPD in the first 30 days following the initial exacerbation 1. However, the most recent and highest quality evidence from the European Respiratory Society/American Thoracic Society guideline 1 takes precedence in guiding the treatment approach.

From the Research

Standard of Care for COPD Exacerbation with Increased Coughing

The standard of care for Chronic Obstructive Pulmonary Disease (COPD) exacerbation with increased coughing involves a combination of pharmacological and non-pharmacological treatments.

• Inhaled bronchodilators, such as short-acting beta-2 agonists and antimuscarinic bronchodilators, are used to relieve bronchospasm and improve lung function 2, 3, 4.
• Corticosteroids, such as prednisone, may be prescribed to reduce airway inflammation and prevent further exacerbations 2, 3, 4.
• Antibiotics may be prescribed if the exacerbation is caused by a bacterial infection 2, 3.
• Oxygen therapy may be necessary to help increase oxygen levels in the blood 5, 3.
• Non-invasive ventilation (NIV) or mechanical ventilation may be required in severe cases of COPD exacerbation 2, 5, 3.

Pharmacological Treatments

• Inhaled short-acting beta-2 agonists, such as salbutamol, can provide quick relief of symptoms 3, 4.
• Inhaled long-acting beta-2 agonists, such as salmeterol and formoterol, can help control symptoms over a longer period 4, 6.
• Inhaled antimuscarinic bronchodilators, such as tiotropium, can help improve lung function and reduce symptoms 4.
• Combination therapy with an inhaled corticosteroid and a long-acting beta-2 agonist may be beneficial for patients with frequent exacerbations 4, 6.

Non-Pharmacological Treatments

• Pulmonary rehabilitation programs can help improve lung function, reduce symptoms, and improve quality of life 2.
• Oxygen therapy can help increase oxygen levels in the blood and reduce shortness of breath 5, 3.
• Non-invasive ventilation (NIV) or mechanical ventilation may be required in severe cases of COPD exacerbation 2, 5, 3.