COPD – exacerbations

COPD patients vary widely, due to their comorbidities, social circumstances, and wishes. So choosing the best treatment pathway for the patient can be complex. Involve senior decision makers.

Questions

Is hospital the best place for them?
Do they need NIV?
Are they dying? – would you want to die surrounded by strangers or with your family?

Investigations – ALL if Admission

Blood gases – Think VBG vs ABG
Chest X-ray
ECG
FBC/U&E + Theophylline level (if on theophylline).
Sputum microscopy and culture (if purulent sputum)
Blood Culture (if suspected sepsis)

Treatments

Will depend on the patient and severity of exacerbation

Initial treatment for ALL: Neb. Controlled O2 and Steroids [<30mins]
Antibiotics [if purulent sputum]
Further treatment to Consider:
- Back to Back Nebs (Salbutamol and Ipratroprium)
- IV Aminophylline
  - 5mg/kg bolus (30min) upto 500mg (if not on theophylline)
  - Maintenance ONLY Aminophylline (post bolus / on theophylline)
- NIV – persisting respiratory acidosis
- Intubation?? (Often not suitable)

NIV – Guide HERE

Should be considered for all COPD patients with a persisting respiratory acidosis after a maximum of one hour of standard medical therapy

Discharge/Admission

This is frequently a difficult decision, with many medical and social influences. Information is key and utilise senior decision-making.

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