COPD Exacerbation (Inpatient)

Dx: Acute respiratory distress 2/2 COPD exacerbation
-Likely 2/2 to ______________________
– admit to telemetry
-Bronchodilators (SAA + SABA): Ipratropium + albuterol nebs or MDI
-Systemic steroids (PO or IV)
-Antibiotics: Will start abx if infection suspected.
-Oxygen: cont O2 supplement & continuous pulse ox.
-NIV as needed.
-Flu / Pneumonia shots.
-f/u CBC & CMP
-Procalcitonin if infection suspected. Helpful for trending to confirm response to tx as well.
-f/u on sputum and blood culture
-f/u on CXR
-TTE and Cardiac enzymes
-Prevention: Smoking cessation discussed and encouraged.
-Prevnar and Pneumovax (upon d/c or from PCP).
-Spirometry and PFTs outpatient when the patient is stable, not recommended during an exacerbation.
–Home meds and discharge recommendations.

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Pearls

• 12-Day Steroid Taper.
• Detailed A/P I have for COPD Exacerbation treatment that also has doses of medications, etc.
• “Non-invasive mechanical ventilation should be the first mode of ventilation used in COPD patients with acute respiratory failure who have no absolute contraindication because it improves gas exchange, reduces work of breathing and the need for intubation, decreases hospitalization duration and improves survival.” GOLD 2017
• Criteria for starting home oxygen.
• COPD Staging by GOLD Guidelines.
• COPD Medications.
• ** If a corticosteroid-dependent COPD patient develops pneumonia, make sure to cover for Pseudomonas. In patients with chronic lung disease who are taking corticosteroids, Pseudomonas is more common than in those with otherwise healthy lungs. The antibiotics chosen empirically should cover Pseudomonas.