An exacerbation of COPD is a sustained worsening of symptoms from the usual stable state and is acute in onset. Frequently reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour (NICE, 2004).
Exacerbations can usually be managed at home unless the exacerbation is severe or of rapid onset, the diagnosis is in doubt, oxygen is needed, or there are other medical or psychosocial reasons for admission.
Increase dose and frequency of inhaled short-acting bronchodilators via spacer.
Prednisone 40mg daily by mouth for 7-14 days.
doxycycline 100mg daily for 7-10 days.
Macrolide antibiotics are often ineffective in bacterial exacerbations of COPD and may also increase theophylline levels.
The earlier an exacerbation is treated the better the results and so most patients who get exacerbations will benefit from having a supply of prednisone and a suitable antibiotic at home.