Hospital treatment in exacerbation of COPD

If hospital treatment is indicated then:

• investigations include:
  • chest X-ray
  • arterial blood gases (record inspired oxygen concentration)
  • ECG
  • blood tests
    • Full blood count and urea and electrolytes
    • Theophylline level on admission if patient is on theophylline therapy
    • Sputum microscopy and culture if purulent
• further management
  • give oxygen to keep SaO2 above 90%
  • assess need for non-invasive ventilation:
    • consider respiratory stimulant non-invasive ventilation not available
    • assess need for intubation
  • if poor response to nebulised bronchodilators then consider intravenous theophyllines

Once stable then consider for hospital-at-home or assisted-discharge scheme.

Before the patient is discharged then establish on optimal therapy and, if necessary, arrange multidisciplinary assessment.

Reference:

1. National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. Jul 2019 [internet publication].
2. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2025 report. 2025 [internet publication].