Acute exacerbations of chronic obstructive pulmonary disease: treatment and prevention

An acute exacerbation of chronic obstructive pulmonary disease (COPD) is sustained worsening of dyspnoea and sputum production in patients with COPD. They may be managed in the community with oral steroids and antibiotics but hospital referral is required where there is doubt about the diagnosis or if there are features of severity such as confusion, respiratory distress or haemodynamic instability. Regular review is required as failure to improve should prompt consideration of another diagnosis. In the emergency department, nebulized β₂-agonists and anticholinergic bronchodilators should be given and arterial blood gases assessed. Patients with an arterial pH of 7.35 or less should be assessed for non-invasive ventilation. Patients who are stable and are not in type 2 respiratory failure should be considered for discharge if there is adequate home support. Warded patients should be discharged if they are stable for 24 hours and if both patient and doctor are confident that they can manage at home with outpatient follow-up at 4 to 6 weeks. About 25% of COPD patients may not have recovered to baseline lung function at this time.