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Chronic obstructive pulmonary disease - Management
How should I treat a person with an acute exacerbation of COPD who is not being admitted?

  • Advise the person to take increased doses or increase the frequency of use of short-acting bronchodilators, for example by doubling the dose or frequency of use.
    • Advise the person to keep to the same delivery system (inhaler with spacer or nebulizer) during an exacerbation as is used on a day-to-day basis, if possible. Explain that both delivery systems (inhaler and spacer or nebulizer) are equally effective, and hospitals use nebulizers mainly for convenience.
    • If a person does not usually use a spacer device, recommend using one, as they may find it easier to use and it will help to deliver a maximum dose.
    • If the person is likely to become fatigued, a nebulizer may be more appropriate.
  • Prescribe systemic corticosteroids for people with a significant increase in breathlessness that interferes with daily activities.
  • Prescribe oral antibiotics for people with a history of more purulent sputum or clinical signs of pneumonia. Consult local antibiotic prescribing guidelines.
    • Initial empirical treatment should usually be:
      • Amoxicillin 500 mg three times daily for 5 days or a tetracycline (for example doxycycline 200 mg on the first day then 100 mg once daily, for a total of 5 days).
      • If the person is allergic to penicillin and doxycycline is contraindicated, prescribe a macrolide (for example erythromycin 500 mg four times daily or clarithromycin 500 mg twice daily for 5 days).
      • If the person has antibiotic resistance risk factors (comorbid disease, severe COPD, frequent exacerbations, or antibiotic use in the past 3 months), prescribe co-amoxiclav 625 mg three times daily for 5 days.

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