Monday, April 13, 2009


Some principles in the management of acute COPD exacerbations:

1. Stability: patients should be in a setting where their vital signs can be monitered closely.

2. Oxygen: can be delivered with increasing capacity. Note that if you are requiring more intense oxygenation, consider other etiologies of hypoxia such as pulmonary embolism. Oxygen can be delivered by....
  • nasal prongs
  • venturi masks (delivered in increasing FiO2's)
  • non-rebreathing masks
  • non-invasive positive pressure ventilation
  • intubation
3. Anticholinergic Agents: short acting ones like Ipratropium Bromide, in frequent and large doses.

4. Beta Agonists: also short acting ones like Salbutamol, also in frequent and large doses.

5. Steroids:
administered PO for most, or IV if your patient is very ill and/or will not tolerate PO meds. Commonly used doses include Prednisone 40-60 mg PO daily, or Methylprednisolone 125 mg IV given 2 times per day. Treatment usually lasts from 5-10 days.

6. Antibiotics:
Indicated in moderate to severe exacerbations. This includes patients who have 2/3 of:
  • increased dyspnea
  • increased sputum purulence
  • increased sputum production
or those requiring invasive ventilation.

7. When the dust settles: After the acute event it is important to counsel patients on smoking cessation, ensure they have their proper vaccines, re-evaluate their medications and ensure they are taking them properly, and possibly arrange for pulmonary rehabilitation.

A good paper on infections in COPD from NEJM.
A review on the management of COPD exacerbations in a case-based approach.

No comments:

Post a Comment