acute COPD exacerbation

Acute Exacerbations

  • increase in severity or frequency of cough
  • worsening dyspnea
  • increase or change in character of sputum
  • triggers: infection, smoking exposures
    • strep pneumo, H flu, moraxella, mycoplasma

management

  • sputum clx: not obtained because rarely affects management
  • SABA with or without SAMA
  • oral glucocorticoids decrease length of stay, 40 mg 5 days
  • abx: moderate or severe exacerbation or mild exacerbation with change in sputum

Antibiotics are generally not recommended for management of acute bronchitis in otherwise healthy individuals as most exacerbations are of viral etiology. However, guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommend antibiotic therapy for patients who have a COPD exacerbation with any two of the following features: increased sputum purulence, increased sputum volume, or increased dyspnea. Antibiotics are also recommended for those requiring mechanical ventilation (noninvasive or invasive).