COPD-MANAGEMENT (EXACERBATION)

SUMMARY

BRONCHODILATORS
1. Salbutamol 8-10 puffs. No evidence that nebuliser is more efficacious than MDI & spacer, but needs 8-10 puffs (= 5 mg neb).

2. Evidence for adding ipratropium is mixed.

SYSTEMIC CORTICOSTEROIDS
3. Prednisone 30-50 mg daily (easier to give 37.5 mg). Improves symptoms, FEV1, PaO2, relapse, length of stay.

4. SE: insomnia, anxiety, depression, deranged BSLs.

5. No advantage over IV except over speed of onset.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].