![]() 6Īntibiotic, broad spectrum (e.g., amoxicillin/clavulanate, macrolides, second- or third-generation cephalosporins, quinolones)Ĭonsider if sputum is purulent or after treatment failure 18, 23, 25 Prophylactic, continuous use of antibiotics does not improve outcomes in patients with COPD. The decision to use antibiotics and the choice of antibiotic should be guided by the patient's symptoms (e.g., presence of purulent sputum), recent antibiotic use, and local microbial resistance patterns. 26 There is no comparable study of narrow-spectrum antibiotics. 25 Another meta-analysis showed no difference in clinical cure rates when broad-spectrum antibiotics were administered for at least five days versus less than five days. One meta-analysis showed a lower risk of treatment failure with broad-spectrum antibiotics compared with narrow-spectrum antibiotics (odds ratio = 0.51 95% confidence interval, 0.34 to 0.75), but no change in mortality rates. Increasing microbial resistance has prompted some physicians to treat exacerbations with broad-spectrum agents, such as second- or third-generation cephalosporins, macrolides, or quinolones. 5 The optimal choice of antibiotic and length of use are unclear. 24 Antibiotics may also benefit patients with mild exacerbations and purulent sputum. The use of antibiotics in moderately or severely ill patients with COPD exacerbations reduces the risk of treatment failure and death. ![]() Long-term oxygen therapy decreases the risk of hospitalization and shortens hospital stays in severely ill patients with COPD. Smoking cessation reduces mortality and future exacerbations in patients with COPD. There is limited evidence that broad-spectrum antibiotics are more effective than narrow-spectrum antibiotics. The choice of antibiotic in patients with COPD should be guided by symptoms (e.g., presence of purulent sputum), recent antibiotic use, and local microbial resistance patterns. Oral prednisolone is equivalent to intravenous prednisolone in decreasing the risk of treatment failure in patients with COPD.īecause they are bioavailable, inexpensive, and convenient, oral corticosteroids are recommended in patients who can safely swallow and absorb them.Īntibiotics should be used in patients with moderate or severe COPD exacerbations, especially if there is increased sputum purulence or the need for hospitalization. Low-dosage corticosteroid regimens are not inferior to high-dosage regimens in decreasing the risk of treatment failure in patients with COPD. Short courses of systemic corticosteroids in patients with COPD increase the time to subsequent exacerbation, decrease the rate of treatment failure, shorten hospital stays, and improve FEV 1 and hypoxemia. Inhaled bronchodilators (beta agonists, with or without anticholinergics) relieve dyspnea and improve exercise tolerance in patients with COPD. Noninvasive positive pressure ventilation improves respiratory acidosis and decreases respiratory rate, breathlessness, need for intubation, mortality, and length of hospital stay. Noninvasive positive pressure ventilation or invasive mechanical ventilation is indicated in patients with worsening acidosis or hypoxemia. Hospitalized patients with exacerbations should receive regular doses of short-acting bronchodilators, continuous supplemental oxygen, antibiotics, and systemic corticosteroids. The choice of antibiotic should be guided by local resistance patterns and the patient's recent history of antibiotic use. Physicians should consider antibiotics for patients with purulent sputum and for patients who have inadequate symptom relief with bronchodilators and corticosteroids. The use of antibiotics reduces the risk of treatment failure and mortality in moderately or severely ill patients. Oral corticosteroids are likely beneficial, especially for patients with purulent sputum. Combining ipratropium and albuterol is beneficial in relieving dyspnea. The first step in outpatient management should be to increase the dosage of inhaled short-acting bronchodilators. Randomized controlled trials have demonstrated the effectiveness of multiple interventions. ![]() Exacerbations of chronic obstructive pulmonary disease contribute to the high mortality rate associated with the disease. ![]()
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