COPD – exacerbations

COPD patients vary widely, due to their comorbidities, social circumstances, and wishes. So choosing the best treatment pathway for the patient can be complex. Involve senior decision makers.


  • Is hospital the best place for them?
  • Do they need NIV?
  • Are they dying? – would you want to die surrounded by strangers or with your family?

Investigations – ALL if Admission

  • Blood gases  – Think VBG vs ABG
  • Chest X-ray
  • ECG
  • FBC/U&E + Theophylline level (if on theophylline).
  • Sputum microscopy and culture (if purulent sputum)
  • Blood Culture (if suspected sepsis)


Will depend on the patient and severity of exacerbation

  • Initial treatment for ALL: Neb. Controlled O2 and Steroids [<30mins]
  • Antibiotics [if purulent sputum]
  • Further treatment to Consider:
    • Back to Back Nebs (Salbutamol and Ipratroprium)
    • IV Aminophylline
      • 5mg/kg bolus (30min) upto 500mg (if not on theophylline)
      • Maintenance ONLY Aminophylline (post bolus / on theophylline)
    • NIV – persisting respiratory acidosis
    • Intubation?? (Often not suitable)

NIV – Guide HERE

Should be considered for all COPD patients with a persisting respiratory acidosis after a maximum of one hour of standard medical therapy


This is frequently a difficult decision, with many medical and social influences. Information is key and utilise senior decision-making.





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