Acute COPD- Treatment

Question 1

Acute COPD exacerbation: goals of therapy

Answer 1

Prevent disease progression, relieve symptoms, improve exercise tolerance, improve overall health status, prevent and treat exacerbations and complications, reduce morbidity and mortality

Question 2

Acute COPD exacerbation: nonpharm treatment

Answer 2

O2: goal is 88-92%
Ventilation: noninvasive mechanical ventilation, intubation and mechanical ventilation
Palliative care

Question 3

Acute COPD exacerbation: pharm treatment (just the drugs)

Answer 3

Bronchodilators: albuterol, ipratropium
Corticosteroids: prednisone or other equivalent
ABX: Augmentin, Unasyn, azithromycin, doxycycline, cefepime, pip/tazo, levofloxacin, carbapenem

Question 4

Acute COPD exacerbation: bronchodilator dosing

Answer 4

1 puff q1h x2-3 doses, then 2 puffs q2-4h

Question 5

Acute COPD exacerbation: bronchodilators clinical pearls

Answer 5

SABA preferred first-line
ACh can be added if symptoms are persistent with an increased dose of SABA

Question 6

Acute COPD exacerbation: prednisone dosing

Answer 6

40mg PO QD

Question 7

Acute COPD exacerbation: prednisone duration of therapy

Answer 7

5 days

Question 8

Acute COPD exacerbation: prednisone formulation

Answer 8

Use PO unless a patient can’t tolerate (N/V, severe dyspnea)

Question 9

When to taper prednisone dose

Answer 9

If treatment >14 days

Question 10

What does prednsione do to recovery time for acute COPD?

Answer 10

Shortens it, also improves FEV1 and oxygenation, decreases risk of relapse/treatment failure and length of hospitalization

Question 11

Criteria to treat COPD exacerbation with ABX

Answer 11

Moderately ill with 3 cardinal signs: increased dyspnea, increased sputum volume, and sputum purulence

2 cardinal symptoms, with one being sputum purulence

Mechanical ventilation

Question 12

How long to treat with ABX for in acute COPD exacerbation

Answer 12

5-7 days

Question 13

Bacteria to treat with ABX in acute COPD

Answer 13

H. influenzae, S. pneumoniae, M. catarrhalis

Question 14

Augmentin dosing for acute COPD

Answer 14

875mg PO BID

Question 15

Unasyn dosing for acute COPD

Answer 15

3gm IV q6h (renally eliminated)

Question 16

Azithromycin dosing for acute COPD

Answer 16

500mg PO QD x3 days, or 500mg x1, then 250mg PO x2-5 days

Question 17

Doxycycline dosing for acute COPD

Answer 17

100mg PO BID x5-7 days

Question 18

ABX to use for pseudomonas risk

Answer 18

cefepime, pip/tazo, levofloxacin, carbapenem

Question 19

Home medications for acute COPD

Answer 19

Can continue LA bronchodilators with or without steroids or start before discharge when the patient is stable

Question 20

What medications should you NOT use

Answer 20

theophylline, chronic suppressive ABX

Question 21

Other treatments to consider

Answer 21

Smoking cessation with nicotine replacement
Immunizations (COVID, Tdap, influenza, pneumococcal)
DVT prophy (enoxaparin 40mg SQ QD or heparin 5000 units SQ q8h)