Chronic obstructive pulmonary disease exacerbation resident survival guide

Definition

COPD exacerbation commonly caused by infections, should be recognized when anyone or more of the following appears acutly in chronic COPD patient^[1]:

Worsening cough
Increasing dyspnea
Increasing in sputum production more than the baseline for chronic COPD Pts^[1]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Differential Diagnosis

Management

COPD Exacerbation
↑cough, ↑dyspnea, ↑sputum,
↑wheezing, fever or chest tightness

Admission

Assessment :
1-O2 sat+ ABG
2-CXR
3-EKG
4-CBC

Management:
1-Inhaled bronchodilators
2-Systemic corticosteroids
3-Empirical antibiotics
4-O2 (target Sat >90%)

Corticosteroids(Solumedrol)
Methylprednisolone 125 mg×1 dose
followed with 60-80 mg Q8-12based on severity
IV Solumedrol to PO Prednisone taper 4--60 mg Q 8-12
2-5 days taper depending on severity
Antibiotics
Group A*
Doxycycline Cap Vibramycin PO 100 mg Q12H
(if unable to tolerate choose Cefpodoxime Tab Vantin PO 200 mg Q12H)
Group B*
Ceftriaxone Inj Rocephin 1GM D5W50 ml Q24H 200 ml/Hr
(If Beta-Lactam allergy choose Levofloxacin Tab Levaquin PO 500 mg daily )
Group C*Ciprofloxacin Tab CiproPO 250 Daily
or Ciprofloxacin Inj Cipro 400 mg premixed at 400 mg /200 ml Q12H 200 ml/Hr.

Respiratory acidosis? OR
PH≤35? OR
PaCo2≥45? OR
Severe signs of dyspnea? OR
(Accessory muscles use,
paradoxical motion of abdomen,
retraction of intercostal space

No

Yes

Continue the same management

ICU Admission
NIV

Unable to tolerate NIV?
Severe hemodynamic instability?
Resp/cardiac arrest ?

Invasive mechanical ventilation

Group A*:mild exacerbation, no risk factors, 2>symptoms present
Group B*:Mod Exacerbation w/risk factors for poor outcomes:comorbid disease, severe COPD, Frequent exacerbation>3, Antimicrobial use within the last 3

months

Group C*:Severe exacerbation w/risk factors for P.aeruginosa infection.

References

↑ ^1.0 ^1.1 Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P; et al. (2007). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". Am J Respir Crit Care Med. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545.

[pmid17507545-1] 1.0 ^1.1 Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P; et al. (2007). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". Am J Respir Crit Care Med. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545.

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