Therapeutic Strategies Acute Exacerbations in Copd

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Bronchodilators, oral corticosteroids, and antibiotics may all be needed to manage an acute exacerbation of COPD. Chronic obstructive pulmonary disease COPD is a major cause of chronic morbidity and mortality throughout the world. Today it is the fourth leading cause of death in the world[ 1 ] and in Canada. Mortality among those who are admitted to hospital with exacerbations varies depending on the severity of the underlying COPD. Precipitating factors Acute exacerbations of COPD are most commonly precipitated by bacterial or viral infection and environmental factors such as air pollution or cold temperatures.

The likelihood of a patient having more than one exacerbation per year increases with advanced age and chronic mucus hypersecretion. A high FEV1 forced expiratory volume in 1 second is protective. Based on these criteria, an exacerbation can be classified as one of three types Table 1. The type of exacerbation along with other clinical features will determine if hospitalization is required. Table 2 [ 19 ].

Management Controlled oxygen therapy.

Treatment options for COPD exacerbations

This is almost always the first treatment given to patients with AECOPD, mainly to prevent life-threatening hypoxemia and optimize oxygen delivery to peripheral tissues and alleviate symptoms, namely dyspnea. Systemic corticosteroids. There is very good evidence that systemic corticosteroids shorten recovery time from an acute exacerbation of COPD and improve lung function in terms of FEV1 and hypoxemia PaO2.

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This group of drugs also reduces the risk of early relapse, treatment failure, and length of hospital stay. A dose of 30 to 40 mg of prednisone per day for 7 to 10 days is recommended. Whereas prophylactic, continuous use of antibiotics has been shown to have no effect on the frequency of exacerbations in COPD, antibiotic use in the management of an acute exacerbation has been shown to reduce short-term mortality and treatment failure rates, mainly in those with moderate to severe COPD exacerbation.

Noninvasive positive pressure ventilation. It should be administered in a setting that allows close cardiopulmonary monitoring. NIPPV used as an adjunct to standard medical care improves alveolar ventilation, decreases the need for endotracheal intubation, reduces treatment failure, and reduces mortality. It also shortens the length of hospital stay by more than 3 days and decreases complications associated with treatment. Invasive mechanical ventilation. Smoking cessation, appropriate use of maintenance medication, pulmonary rehabilitation, and immunizations all have important roles to play see Part 1 of this theme issue.

They should be treated with bronchodilators as well as oral corticosteroids. If the patient has acute bronchitis, antibiotic therapy should be considered. Competing interests Dr FitzGerald has received honoraria for consulting and providing continuing medical education as well as being an investigator on research projects which have been funded by research grants provided to the University of British Columbia from pharmaceutical companies who manufacture therapies for use in chronic obstructive lung disease.

Am J Med ; Burrows B, Earle RH. Course and prognosis of chronic obstructive lung disease: A prospective study of patients.

What Is the Appropriate Use of Antibiotics In Acute Exacerbations of COPD? | The Hospitalist

N Engl J Med ; Can Resp J ; Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Lower respiratory illnesses promote FEV1 decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease: Results from the lung health study. The necessary length of hospital stay for chronic pulmonary disease.

JAMA ; Outcomes following acute exacerbation of severe chronic obstructive lung disease. Acute respiratory failure in chronic obstructive pulmonary disease. Immediate and long-term prognosis. Arch Intern Med ; Determinants of immediate survival among chronic respiratory insufficiency patients admitted to an intensive care unit for acute respiratory failure. A prospective multicenter study. Chest ; Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease.

I. Background and Objectives for the Systematic Review

The researchers found that participants who underwent NIV had a 46 percent lower risk of death than those who did not undergo NIV. NIV treatment also reduced the length of hospital stays and lowered the risk of experiencing COPD-related complications. During intubation, a specialist will insert a breathing tube into a person's windpipe to allow for mechanical ventilation, or assisted breathing. The specialist will then connect the breathing tube to a ventilator, which is also known as a breathing machine or a respirator.

Doctors may use a ventilator if a person is unable to breathe on their own, or their breathing is ineffective at removing carbon dioxide or oxygenating the lungs. The machine can deliver a set number of breaths per minute, a volume of air, and pressure to the lungs. It also delivers oxygen. It is critical for a person to begin treatment for a flare-up of COPD symptoms as soon as possible. Exacerbations can trigger a decrease in oxygen levels in the blood or issues removing carbon dioxide from the body, which can result in respiratory failure.

Recognizing the signs of a COPD exacerbation quickly and seeking appropriate treatment may prevent a flare-up from becoming life-threatening. A person may treat a COPD exacerbation at home using oxygen and medications. However, there may be other cases in which hospitalization is needed. At the hospital, medical professionals can continuously monitor a person, as well as administer specialized treatment. COPD exacerbations are events during which a person's symptoms suddenly become worse or new symptoms develop.

Certain strategies, such as avoiding triggers, can help reduce the chance of experiencing a COPD exacerbation. However, it is not always possible to prevent them. Treatment depends on the type and severity of the exacerbation and can include bronchodilators, corticosteroids, antibiotics, oxygen therapy, and ventilation.

Sometimes, a person may need more than one form of treatment. Prompt recognition and treatment of a COPD exacerbation can reduce the need for hospitalization and may lower the risk of complications.


A doctor can provide a treatment and action plan for dealing with exacerbations. Article last reviewed by Tue 30 October All references are available in the References tab. Osadnik, C. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease.

Stefan, M. Association between antibiotic treatment and outcomes in patients hospitalized with acute exacerbation of COPD treated with systemic steroids. Chest , 1 , 82— Ucar, E. Akgun, M.

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Two different dosages of nebulized steroid versus parenteral steroid in the management of COPD exacerbations: A randomized control trial. Medical Science Monitor , 20 , — What is a COPD exacerbation? MediLexicon, Intl. MNT is the registered trade mark of Healthline Media. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Privacy Terms Ad policy Careers.

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Reviewed by J. Keith Fisher, M. Prevention Takeaway. A bronchodilator can open the lungs to ease the symptoms of a COPD exacerbation.

Management of COPD Exacerbations

How to manage COPD triggers. In this article, learn more about how to identify and manage common COPD triggers. People with severe COPD exacerbation may need treatment with noninvasive ventilation. Image credit: James Heilman, Quitting smoking can help prevent COPD exacerbations. Related coverage.

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