From the Guidelines
Treatment options for Chronic Obstructive Pulmonary Disease (COPD) exacerbation are primarily focused on symptom resolution and recovery. The main treatment options include:
- 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, oxygenation, and shorten recovery time and hospitalization duration 1.
- Antibiotics: Indicated when there is evidence of bacterial infection, and they shorten recovery time and reduce the risk of early relapse, treatment failure, and hospitalization duration 1.
- Supplemental oxygen: For hypoxaemic patients 1.
- Noninvasive mechanical ventilation (NIV): Should be the first mode of ventilation used to treat acute respiratory failure 1. Additional treatments such as mucolytics and aminophyllines have been studied, but their role is less clear 1. Pulmonary rehabilitation and home-based management programs may also be beneficial in certain cases 1. The choice of treatment should be individualized based on the severity of the exacerbation, the patient's underlying health status, and other factors.
From the Research
Treatment Options for COPD Exacerbation
The treatment options for Chronic Obstructive Pulmonary Disease (COPD) exacerbation can be categorized into acute management, prevention of early recurrence and readmission, and long-term prevention.
- Acute management includes:
- Corticosteroids or antibiotics 2
- Non-invasive ventilation (NIV) 2, 3
- Inhaled bronchodilators (i.e., short-acting β2-agonists and anticholinergics) and systemic corticosteroids 4
- Other drugs such as inhaled anesthetic agents, ketamine, intravenous methylxanthines, and magnesium, which are essentially only used in the ICU setting 4
- Prevention of early recurrence and readmission:
- Long-term prevention:
- Inhaled therapy, with dual bronchodilators reducing exacerbation frequency 2
- Triple therapy should be considered, especially if blood eosinophils are elevated 2
- Other options include phosphodiesterase inhibitors and macrolide antibiotics 2, 4
- Supplemental oxygen for patients with resting hypoxemia (defined as Spo2 <89%) improves survival 5
Pharmacological Treatment
Pharmacological treatment options for COPD exacerbation are broad, and a better understanding of clinical phenotypes and biomarkers may help to establish a more tailored approach 2.
- Current therapies are not effective in modifying the prognosis of patients with COPD, and new therapeutic options to address infection and inflammation in COPD are needed to improve the outcome of exacerbations 4, 3
- Targeted therapies directed towards specific pathways of inflammation are being explored in exacerbation prevention, and this is a promising avenue for future research 2, 6