Management of Stable COPD
Phase 3 - Treating Acute Exacerbations of COPD in the Outpatient Setting

During an acute exacerbation of COPD, the physician will need to increase inhaled bronchodilator frequency, possibly add an updraft nebulizer, treat underlying sinusitis or pulmonary infection (See Section H.1), and frequently add a course of corticosteroids to prevent further deterioration and to avoid hospitalization resulting from increasing bronchospasm, air trapping, respiratory muscle fatigue, and ultimately respiratory failure. Oxygen needs should be assessed and oral bronchodilator medication added or increased, if tolerated. Inhaled bronchodilators give the patient the most rapid relief from acute bronchospasm, and continuous nebulization of albuterol has been shown to be safe for status asthmaticus for 45 to 90 minutes.

Indications for emergent hospitalization include: acute respiratory failure manifested by either worsening hypoxemia or acute respiratory acidosis; clinical signs of marked fatigue secondary to the increased work of breathing and manifested by tachypnea (respiratory rate greater than 30 breaths per minute), tachycardia, and the vigorous use of accessory respiratory muscles; and/or pneumonia causing respiratory compromise or other medical complications.