Most exacerbations can be safely managed in the community.
Consider these medications
Beta 2-agonist +/- anticholinergic or usual inhaler. Use high dose, 4 - 6 puffs MDI with large volume spacer for best delivery. Only use a nebuliser if absolutely necessary.
In most instances, inhalers used with a spacer device will be sufficient for the management of acute symptoms. If using a nebuliser, avoid high flow oxygen in patients at risk of CO2 retention.
In moderate to severe exacerbations. 40 mg daily for 3-7 days, then 20 mg daily for 3-7 days. No additional benefit is gained from longer courses and long term use is not recommended. Dose tapering is not required if used short-term.Avoid multiple short courses of treatment and this in itself should prompt review.
Consider Sputum testing
Note: If requested, non-tuberculous mycobacteria may be isolated in some cases. The significance of single isolates is often unclear. Repeat sputum testing in the first instance. Consider seeking written specialist advice.
In severe COPD with exacerbations
Consider a home supply:
The earlier an exacerbation is treated the better the results and therefore most patients who get exacerbations will benefit from having a supply of prednisone (40mg 7-10 days) and a suitable antibiotic (amoxicillin or doxycycline) at home with instructions on how and when to use them. Antibiotic only if increased volume of purulent sputum. BPAC Guidelines for primary management of COPD.
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