COPD Exacerbation — Steroids, Antibiotics & NIV

Key Points

• Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
• Use system-specific risk tools to guide testing and disposition.
• Order high-yield tests first; escalate imaging when indicated.
• Start evidence-based initial therapy and reassess frequently.

Algorithm

1. Primary survey and vitals; IV access and monitors.
2. Focused history/physical; identify red flags and likely etiologies.
3. Order system-appropriate labs and imaging (see Investigations).
4. Initiate guideline-based empiric therapy (see Pharmacology).
5. Reassess response; arrange consultation and definitive management.

Clinical Synopsis & Reasoning

COPD exacerbations are marked by increased dyspnea, cough, and sputum changes, often precipitated by viral/bacterial infection or environmental exposure. Assess for hypercapnic respiratory failure and co‑morbid cardiopulmonary disease; obtain CXR to exclude pneumonia or pneumothorax when indicated.

Treatment Strategy & Disposition

Treat with short‑acting bronchodilators, systemic corticosteroids, and antibiotics when Anthonisen criteria are met or severe disease is present. Provide oxygen targeting 88–92% to avoid CO₂ retention; use NIV for acute hypercapnic failure when appropriate. Optimize maintenance inhalers and arrange pulmonary rehab/smoking cessation. Disposition ranges from outpatient management to ICU depending on gas exchange and clinical trajectory.

Management Notes

Use ABG to evaluate hypercapnia in severe cases. Educate on action plan and inhaler technique.

Epidemiology / Risk Factors

• Smoking/chronic lung disease; infections or immobility (VTE)

Investigations

Antibiotics (Examples)

Pharmacology

Prognosis / Complications

• Depends on severity/oxygenation; respiratory failure risk

Patient Education / Counseling

• Explain red flags and when to seek emergent care.
• Reinforce medication adherence and follow-up plan.

References

1. GOLD Report — Exacerbation — Link