From the Guidelines
The treatment setting for acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) can be either outpatient or inpatient, depending on the severity of the exacerbation.
Treatment Settings
- Outpatient setting: For ambulatory patients with a COPD exacerbation, a short course of oral corticosteroids and antibiotics may be suggested, as well as the use of bronchodilators and supplemental oxygen 1.
- Inpatient setting: For patients who are hospitalized with a COPD exacerbation, oral corticosteroids are suggested, rather than intravenous corticosteroids, if gastrointestinal access and function are intact 1. Noninvasive mechanical ventilation is recommended for patients with acute or acute-on-chronic respiratory failure 1.
Home-Based Management
- Hospital-at-home: A home-based management program may be suggested for patients with a COPD exacerbation who present to the emergency department or hospital, as an alternative to hospitalization 1.
Pulmonary Rehabilitation
- Post-hospitalization: Pulmonary rehabilitation may be initiated within 3 weeks after hospital discharge for patients who were hospitalized with a COPD exacerbation 1. It is essential to consider the individual patient's needs and circumstances when determining the treatment setting for a COPD exacerbation, and to coordinate care between subspecialists and primary care physicians 1.
From the Research
Treatment Setting for Acute Exacerbation of COPD
The treatment setting for acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) can vary depending on the severity of the exacerbation.
- For severe exacerbations, hospitalization is often required, particularly for those with respiratory failure or requiring intensive care unit (ICU) admission 2, 3, 4, 5.
- In the hospital setting, treatments may include inhaled bronchodilators, steroids, antibiotics, oxygen, and noninvasive ventilation 2, 3, 4, 5.
- For less severe exacerbations, treatment may be managed on an outpatient basis, with similar treatment modalities used as in the hospital setting 6, 4, 5.
- Nonpharmacological interventions, such as disease-specific self-management, pulmonary rehabilitation, and early medical follow-up, may also be used in the treatment of acute exacerbations of COPD 4.
Severity of Exacerbation
The severity of the exacerbation plays a significant role in determining the treatment setting.
- Severe exacerbations, characterized by respiratory failure or requiring ICU admission, require hospitalization and more intensive treatment 2, 3, 4, 5.
- Less severe exacerbations may be managed on an outpatient basis, with closer monitoring and follow-up 6, 4, 5.
Treatment Modalities
The treatment modalities used for acute exacerbations of COPD include:
- Inhaled bronchodilators, such as short-acting β2-agonists and anticholinergics 2, 3, 4, 5.
- Systemic corticosteroids 2, 3, 4, 5.
- Antibiotics, particularly for those with bacterial infections 2, 3, 4, 5.
- Oxygen therapy, particularly for those with hypoxemia 2, 3, 4, 5.
- Noninvasive ventilation, particularly for those with respiratory failure 2, 3, 4, 5.