From the Guidelines
The most appropriate additional management for this 61-year-old woman with a COPD exacerbation is prednisone (option C). Systemic corticosteroids are a cornerstone of treatment for COPD exacerbations, as they help reduce airway inflammation, decrease recovery time, and improve lung function. For acute exacerbations, a short course of oral prednisone (typically 40 mg daily for 5 days) is recommended, as stated in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report 1. This patient presents with classic symptoms of a COPD exacerbation including increased dyspnea and purulent sputum, and she has already been started on appropriate bronchodilator therapy (nebulized albuterol) and antibiotic coverage (azithromycin) for the likely infectious component. Her arterial blood gas shows adequate oxygenation and no significant respiratory acidosis (pH 7.36, PCO2 43 mm Hg), indicating that respiratory support options like high-flow nasal cannula or noninvasive ventilation are not necessary at this time. While sputum cultures can be helpful in guiding antibiotic therapy, empiric antibiotic coverage has already been initiated, making corticosteroid therapy the most important addition to her current management plan to help resolve her exacerbation, as supported by the GOLD report 1 and other guidelines 1. Key points to consider in the management of COPD exacerbations include the use of short-acting inhaled β2-agonists, with or without short-acting anticholinergics, as initial bronchodilators, and the initiation of maintenance therapy with long-acting bronchodilators as soon as possible before hospital discharge 1. Additionally, systemic corticosteroids improve lung function and oxygenation, and shorten recovery time and hospitalization duration, while antibiotics, when indicated, shorten recovery time and reduce the risk of early relapse, treatment failure, and hospitalization duration 1. In this case, the patient's presentation and current management make prednisone (option C) the most appropriate additional management.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Additional Management for COPD Exacerbation
The patient is experiencing a COPD exacerbation characterized by increased dyspnea and purulent sputum production. The current management includes nebulized albuterol and oral azithromycin.
- The most appropriate additional management would be to add C Prednisone, as systemic corticosteroids have been shown to reduce the risk of treatment failure and relapse by one month, and improve lung function and symptoms in patients with COPD exacerbations 2.
- The use of systemic corticosteroids, such as prednisone, is supported by high-quality evidence, which demonstrates a significant reduction in treatment failure and relapse rates, as well as improved lung function and symptoms 2.
- While noninvasive bilevel positive airway pressure ventilation (Option B) and high-flow nasal cannula (Option A) may be considered in certain cases, they are not the most appropriate additional management in this scenario.
- Sputum culture (Option D) may be considered to guide antibiotic therapy, but it is not the most appropriate additional management for this patient.
Rationale for Choosing Prednisone
- The patient's symptoms and arterial blood gas results indicate a need for anti-inflammatory treatment to reduce airway inflammation and improve lung function.
- Systemic corticosteroids, such as prednisone, have anti-inflammatory effects and can help reduce airway inflammation and improve symptoms in patients with COPD exacerbations 3.
- The use of prednisone is supported by clinical guidelines, which recommend the use of systemic corticosteroids in patients with COPD exacerbations 4.