Acute Exacerbation of COPD

Treatment Criteria & Considerations

Cardinal Symptoms

  • The use of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is controversial

  • Antimicrobial therapy is only recommended when AECOPD is accompanied by an acute change in all 3 cardinal symptoms or at least 2 of the 3 cardinal symptoms, if increased sputum purulence is one of the 2 symptoms.

  • Cardinal symptoms include:
    1. Increased dyspnea
    2. Increased sputum volume
    3. Increased sputum purulence

  • See link below for evaluation and treatment algorithm

Patients receiving invasive or non-invasive ventilation for AECOPD should be initiated on intravenous antimicrobial therapy

If infiltrate on chest x-ray consistent with infection or pneumonia suspected, then treat as per pneumonia treatment guidelines (see Community Acquired Pneumonia below)

Consider nasopharyngeal swab for influenza if seasonal influenza is circulating within the community.

  • If swab positive: consider stopping antibacterial therapy

  • If swab negative: stop antiviral therapy if started

Evaluation and Treatment Algorithm

Shortcuts

More Information

Guideline content derived from:

  • NB Provincial Health Authorities Anti-Infective Stewardship Committee. Antimicrobial Therapy for Acute Exacerbation of Chronic Obstructive Pulmonary Disease. 05-2019.

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