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If you have identified a patient as having an acute exacerbation of COPD:
Chest X-ray, ABG, ECG and routine bloods, sputum cultures if the patient is productive of sputum and blood cultures if the patient is pyrexic.
In the absence of significant contraindications prescribe oral Prednislone 30mg for 5 days.
If you think the exacerbation is infective follow antimicrobial advice:
In addition prescribe nebulised or inhaled bronchodilators depending on symptom severity (most hospitalised patients with COPD will need nebulised therapy for the initial period of treatment, usually prescribed regularly eg. four times a day, in addition to as required):
We generally recommend that patients are off nebulised bronchodilators for 24 hours before discharge. There are a number of other interventions which should be considered at the time of discharge, ideally with delivery of a COPD discharge bundle. These interventions should include:
The most recent guideline which covers the management of COPD exacerbation in the UK is the 2018 NICE guideline Chronic obstructive pulmonary disease in over 16s: diagnosis and management which can be accessed at:
Differentiation of Chronic Breathlessness: Common Presentations of Asthma, COPD & Heart Failure
Consider emergency referral to acute services
|Consider diagnosis of Asthma||
Consider diagnosis of COPD
|Consider diagnosis of Heart Failure|
Consider a diagnosis of COPD in patients who are:
Pose bronchodilator spirometry showing FEV1/FVC of 0.70 is essential for diagnosis of airflow obstruction.
Widely used for its impactful message about the comparative value of interventions for COPD that rebalances the value accorded to flu vaccination, stop smoking as a treatment, pulmonary rehabilitation, inhaled medicines and telemedicine using cost per quality adjusted life year (QALY).
It may be appropriate in some cases to consider stepping down inhaled corticosteroid treatment, particularly in patients with previous pneumonia and those who are predominantly symptomatic but not exacerbating. This should be done cautiously, using the NHS Highland Guideline below for the withdrawal of Inhaled Corticosteroids (ICS) in patients with COPD.
When discontinuing ICS, it may be worthwhile checking blood eosinophil (provided not on oral /L corticosteroids). An eosinophil count <0.3x109 /L adds confidence that ICS may not be required.
If increased exacerbations reconsider need for ICS and consider undiagnosed asthma
Anti-tussives are not recommended.
→ prednisolone 30mg once daily for 5 days
→ consider GI and bone protection (particularly if 3-4 courses annually)
→ doses of up to 40mg daily for up to three weeks do not usually need to be tapered down, however be aware if patients have had multiple recent courses, they may require a gradual dose reduction, and some patients require a long term maintenance dose of oral corticosteroid.
Referral for advice, specialist investigations or treatment may be appropriate at any stage of disease, not just for people who are severely disabled.
Possible reasons for referral include:
Send patient spirometry with referral
A palliative approach should be considered in the care of those individuals who
A palliative approach includes holistic assessment and regular review along with consideration of referral to specialist palliative care services for complex symptom control and psychospiritual support.
Requires practitioners to adopt a thinking ahead approach that allows them to work with patients and those close to them to set and achieve goals that will ensure the right thing is being done, at the right time, by the right person(s) with the right outcome.
ACPA (Anticipatory Care Patient Alert)
Long Term Conditions ACPA Form
|SOB||Shortness of breath|
|BPM||Beats per minute|
|CAT score||COPD Assessment Test score|
|LAMA||Long-acting muscarinic antagonist|
|LABA||Long-acting beta2 agonist|
Last reviewed: 03 December 2021
Next review: 03 December 2024
Author(s): Advanced Practice Respiratory Nurse
Approved By: TAM Subgroup of ADTC
Reviewer Name(s): Advanced Practice Respiratory Nurse
Document Id: TAM367