Respiratory  |  COPD Pathway - Acute Exacerbations in General Practice


COPD Pathway - Acute Exacerbations in General Practice

Most exacerbations can be safely managed in the community.

Consider these medications

  • Short Acting beta Agonist:

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.

  • Nebuliser:

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.

  • Prednisone:

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.

  • Antibiotic:
Only if increased volume of purulent sputum.
A suitable antibiotic at home with instructions on how and when to use them
  • Amoxicillin 500 mg 3 times daily or
  • Amoxicillin/clavulanate 500/125 mg 3 times daily or
  • Doxycycline 100 mg bd for 1 day, then 100 mg daily or
  • Roxithromycin 150 mg bd.

Consider Sputum testing

  • Consider sputum testing if patients do not seem to respond to a course of antibiotics.
  • Aspergillus commonly can be isolated during or after courses of antibiotic therapy and is significant only if isolated repeatedly or if fungal hyphae are seen on microscopy.
  • Patients receiving frequent courses of antibiotics may develop problems with resistant organisms (such as penicillin resistant pneumococci) or become colonised / infected with less common organisms (such as Pseudomonas aeruginosa, Sternotrophomonas maltophilia, etc).

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.

  1. Urgent hospital admission if cyanosed or drowsy or consider admission if not responding to treatment.
  2. Monitor for other conditions, e.g., heart failure, asthma.

Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016

Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.