Acute COPD exacerbation

Question 1

1. Oxygen therapy

Answer 1

Sit-up
24% O2 via Venturi mask: SpO2 88-92%,
Vary FiO2 and SpO2 target according to Arterial Blood Gas

Question 2

2. Nebulised bronchodilators

Answer 2

Salbutamol 5mg/4h
Ipratropium 0.5mg/6h

Question 3

3. Steroids

Answer 3

Hydrocortisone 200mg IV
Prednisolone 40mg PO for 7-14d

Question 4

4. Antibiotics

Answer 4

If infection signs

Question 5

5. Further treatment if no response

Answer 5

Repeat nebulisers and consider aminophylline IV
NIV (BiPAP) if pH <7.35 and/or RR >30
Consider invasive ventilation if pH<7.26

Question 6

Summary of acute COPD exacerbation treatment

Answer 6

1. Oxygen therapy
2. Nebulised bronchodilators
3. Steroids
4. Abx
5. Further treatment e.g. aminophylline, NIV or IV