Summary and References

Tips for COPD

• Identify clinical indicators of bacterial infection warranting antibiotics, such as increased sputum purulence, increased sputum volume, and respiratory failure. Antibiotics are not routinely indicated for all COPD exacerbations.
• Recognize the recommended duration of systemic corticosteroid therapy based on the severity of the exacerbation. For hospitalized patients, 5-7 days is appropriate. Longer courses have not shown added benefits.
• Understand the indications and contraindications for non-invasive ventilation in COPD exacerbations. It is the preferred modality for respiratory failure, but is contraindicated with altered mental status or hemodynamic instability.

Summary

COPD exacerbations represent acute worsening of respiratory symptoms in patients with underlying COPD. Key symptoms are increased dyspnea, cough, and sputum production. Exacerbations result from increased inflammation, bronchospasm, and mucus production in the airways. Treatment focuses on optimizing bronchodilation with short-acting inhaled beta-agonists and anticholinergics. Systemic corticosteroids speed recovery but optimal dosing and duration are unclear. Antibiotics are recommended empirically if purulent sputum or respiratory failure occurs.

Non-invasive ventilation is first-line for respiratory failure, but intubation with lung-protective ventilation may be required in severe exacerbations. Critical management principles include maximizing bronchodilation, reducing inflammation, treating infection, and providing respiratory support. Clinical pharmacists play a vital role in ensuring evidence-based therapies are implemented, monitoring for treatment response, and educating patients regarding COPD self-management. Key guidelines include the GOLD Report with recommendations on systemic corticosteroids, antibiotics, bronchodilators, and ventilator strategies graded by level of evidence. With expertise in managing COPD exacerbations, pharmacists can significantly improve patient outcomes.

References

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