III. Management: Exacerebation Pre-planning

  1. Emergency prescriptions (available at home in case of exacerbation)
    1. Supply Albuterol MDI or nebulizer solution
    2. Supply Prednisone 40 mg orally daily for 5 days
    3. Supply antibiotic for 5 days to cover in case of uncomplicated Chronic Bronchitis exacerbation
      1. See Antibiotic Use in COPD Exacerbation
      2. First-Line: Bactrim, Doxycycline or Amoxicillin
      3. Alternative: Augmentin, Zithromax or Clarithromycin
  2. Advanced Directives
    1. Have a Dyspnea crisis plan for end-stage COPD
    2. Review Resuscitation status wishes
    3. Complete POLST forms and make available at home as well as with primary provider, hospital and EMS
    4. Consider Hospice for end-stage COPD

IV. Indications: Phone Contact

  1. Worsening symptoms (patient should call clinic)
    1. Dyspnea
    2. Sputum Color change
    3. Sputum volume increase
  2. Phone follow-up (clinic should call patient)
    1. Routine triage nurse or provider phone call follow-up 2 days after start of exacerbation
    2. Set up clinic exam within 7 days of COPD exacerbation

V. Management: Home

  1. Continue home management protocol
    1. See COPD Management for GOLD Criteria and stepped approach to care
    2. Long-acting Bronchodilators (e.g. Tiotropium, Salmeterol)
    3. Inhaled Corticosteroids (e.g. Fluticasone) if indicated
  2. Initiate acute management
    1. Increase use of Albuterol MDI or nebulizer (rescue Inhaler)
    2. Start Prednisone 40 mg orally daily for 5 days (see emergency prescriptions listed above)
    3. Start antibiotic for 5 days (see emergency prescriptions listed above)

VI. References

  1. (2014) Presc Lett 21(1): 2

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window