Management

 

Increasing bronchodilator frequency: by increasing dose, adding a SABA or ipratropium if not already prescribed.

 

Oral antibiotics (if sputum is purulent or there are signs of pneumonia): The infection may be bacterial or viral. Bacteria associated with this include Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis. The choice of antibiotic is usually between an aminopenicillin, a macrolide or a tetracycline.

 

Systemic corticosteroids (if experiencing persistent shortness of breath): Prednisolone 30mg/day for 7-14days to increase the FEV1. It should be taken as a single dose in the morning to reduce the effect on circadian cortisol secretion.

Mechanism of action: binds to cytosolic glucocorticoid receptors which translocate to the nucleus, binding to glucocorticoid response elements (they regulate gene expression). It upregulated anti-inflammatory genes and downregulates pro-inflammatory genes such as cytokines and tumour necrosis factor.

For further information see Oral Therapies page.

 

Methylxanthines: IV theophylline can be given but only if there has been an inadequate response to nebulised bronchodilators. Care is needed due to interactions and narrow therapeutic index which could cause toxicity if they have been taking oral theophylline.

 

Oxygen: if blood oxygen saturation < 90%. Care is needed due the risk of respiratory depression (see Oxygen Therapy page).

 

All patient should have a follow up appointment after their exacerbation when they are clinically stable (e.g. six weeks later). At this point their self-management plan can be reviewed.