Funding for this paper was provided by Novartis Portugal. © 2018 Published by Elsevier España, S.L.U. Int J Chron Obstruct Pulmon Dis, 10 (2015), pp. Cohen, M.C. The journal is printed in English, and is freely available in its web page as well as in Medline and other databases. After an exacerbation is appropriately managed, a suitable discharge plan should be prepared. COPD in the Hospital and the Transition Back to Home A big concern for people with COPD is getting sick with a COPD flare-up and being admitted to the hospital. Continuing navigation will be considered as acceptance of this use. D.J. Many patients experience exacerbations and some require Emergency Room visits and hospitalization. It is important to identify the underlying cause of an exacerbation as this will guide the therapeutic strategy. COPD overview. Ficker, D.E. Ouellette, D. Goodridge, P. Hernandez. They suggested that NB might be an alternative to OP for the treatment of acute nonacidotic exacerbation of COPD. Some biomarkers have been suggested as useful for optimizing antibiotic treatment. C. Salturk, Z. Karakurt, N. Adiguzel, F. Kargin, R. Sari, M.E. A clinical in-hospital prognostic score for acute exacerbations of COPD. This observation is corroborated by a Cochrane review demonstrating that procalcitonin can guide antibiotic therapy.32 In contrast, other authors reported that CRP might be a more valuable marker,34 and a real-life primary care study concluded that performing CRP rapid tests led general practitioners to prescribe fewer antibiotics than those who did not.35. F. Rivas-Ruiz, M. Redondo, N. Gonzalez, S. Vidal, S. Garcia, I. Lafuente. AR declares having received speaking fees from AstraZeneca, Boehringer Ingelheim, Novartis, Bial, Medinfar, Mundipharma, Menarini, Grifols, Mylan, Tecnifar, Teva and cslbehring. Vollenweider, H. Jarrett, C.A. If the patient is admitted to the ICU, besides the tests recommended in severe exacerbations, the Glasgow Coma Scale5 should be used, respiratory tract infections investigated25 and a hemoculture performed.24 According to the GOLD 2018 document only patients requiring non-invasive ventilation (NIV) or invasive ventilation (IV) should be hospitalized.1, Short-acting inhaled β2 agonists (SABAs) and short-acting muscarinic antagonists (SAMAs) remain the mainstay in the treatment of symptoms and airflow obstruction during COPD exacerbations.1,4,6 Although at the time of publication of the GOLD 2018 document there were no clinical studies evaluating the usefulness of long-acting β2 agonists (LABA) or long-acting muscarinic antagonists (LAMA) in exacerbations, the recommendation is to continue this medication during the exacerbation or to start it as soon as possible before hospital discharge.1 The LABA+LAMA combination does have a documented benefit in the reduction of exacerbations when prescribed to patients in the stable phase of COPD,26 particularly the indacaterol/glycopyrronium combination as demonstrated in the SPARK27 and FLAME28 studies. Referral to a Pulmonology Consultation if the patient is not already attending one is of the utmost importance. Synopsis: A total of 318 patients admitted for COPD exacerbation were randomized to standard or eosinophilia-guided therapy. The authors do not advise the use of COPD Assessment Test (CAT) score23 routinely in Portugal as it is not validated for the Portuguese population. J.A. Three prognostic scores have been proposed based on biological and clinical characteristics of exacerbations: the BAP-65 score,9 the DeCOPD score9 and the score proposed by Roche et al.10,11. Science Citation Index Expanded, Journal of Citation Reports; Index Medicus/MEDLINE; Scopus; EMBASE/Excerpta Medica, The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years.© Clarivate Analytics, Journal Citation Reports 2020, CiteScore measures average citations received per document published. G.J. Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD. Le Monnier, Int J Chron Obstruct Pulmon Dis, 10 (2015), pp. Heterogeneity of chronic obstructive pulmonary disease exacerbations: a two-axes classification proposal. Diekemper, D.R. Chapman, J. Vestbo, N. Roche, R.T. Ayers. Most patients with exacerbation of chronic obstructive pulmonary disease (COPD) require oxygen supplementation during an exacerbation. The best treatment for an exacerbation … Although the most effective duration of treatment is still to be defined,32 the recommended length of antibiotic therapy is usually 5–7 days (Evidence D)1 but treatment duration will depend on the antibiotic used. J Eval Clin Pract, 21 (2015), pp. 61-71, © Copyright 2021. on behalf of Sociedade Portuguesa de Pneumologia. The mainstays of the treatment of exacerbation of COPD in the prehospital setting include: • Ensuring adequate ventilation and oxygenation (SpO288%–92%); • In intubated patients, adjusting minute volume and inspiratory flow rates when possible to prevent dynamic hyperinflation; • Administration of nebulized bronchodilators; • IV access and cardiac monitoring. S.L. The NHS protocol for management of COPD exacerbations in primary care states that bronchodilators and corticosteroids are the mainstay of exacerbation treatment. The authors propose that the patient should be prescribed an anti-pneumoccocal vaccine 10 to 20 days after discharge from the ER or Hospital. Patients (or home caregivers) should be given appropriate information to enable them to fully understand the correct use of medications, including inhalers and oxygen, and, if necessary, arrangements for follow-up and home care (such as visiting nurse, oxygen delivery, referral for other support) should be made. Funding was used to access all necessary scientific bibliography and cover meeting expenses. SF declares no conflicts of interest. When should acute exacerbations of COPD be treated with systemic corticosteroids and antibiotics in primary care: a systematic review of current COPD guidelines. Pharmacological strategies to reduce exacerbation risk in COPD: a narrative review. J.D. Chronic Obstructive Pulmonary Disease (COPD) is a serious pulmonary condition. Pulse oximetry should be performed on all patients.6 If a patient is referred to a hospital, arterial blood gases should be measured5,6,8,15,19–21 and a chest radiography should be done to exclude comorbidities and/or other pulmonary diseases.1,6,8,15,19 In these cases, it is also recommended that patients should have an ECG,1,6,19,20 whole blood count,1,6,8,20–22 and basic biochemical tests, including electrolyte concentrations,1,8,20,21 urea,8 glycemia1,20 and metabolic panel.6 Theophylline levels should be measured in patients on theophylline therapy at admission and blood cultures should be taken if the patient has fever.8 Culture of sputum samples is not recommended in routine practice, only if sputum is purulent,8 and the GOLD 2018 document recommends sputum culture and an antibiotic sensitivity test only if an infectious exacerbation does not respond to the empirical antibiotic treatment.1 Some authors mention eosinophilia blood count as an advisable procedure to guide COPD exacerbations therapy since it has been suggested that eosinophilic exacerbations may be more responsive to systemic steroids.1,15 Spirometry is not recommended during an exacerbation.1, If the exacerbation is severe and the patient hospitalized, brain natriuretic peptide and cardiac enzyme measurements levels should be considered, especially if the patient is not responding to conventional treatment.6 Also, pharyngeal swab or sputum should be tested for viruses and bacteria14,20,23 and serum C-reactive protein measured.14,20,24 Procalcitonin may guide antibiotic therapy since it has been suggested as a more specific marker for bacterial infections and that may be of value in deciding on antibiotics prescription.1 The Charlson comorbidity index,5,20,21,23 the modified Medical Research Council (mMRC) dyspnea scale,5,20,21,23 physical activity5 and general health5 should be assessed. Rev Port Pneumol (2006), 22 (2016), pp. Novartis Portugal had no role in the collection, analysis and interpretation of data, in the writing of the paper and in the decision to submit the paper for publication. Admissions to hospital for COPD are highest in winter and early spring and are consistent with the trend for acute respiratory infections, such as rhinovirus (common cold), influenza, pneumonia and acute bronchitis (Figure 3). Tsui, S.L. Pharmacological treatment should be optimized. The average person with COPD has between 0.85 ... 5 Treatment Options for COPD Exacerbation. 2. Shatoria Grant These findings are expected for COPD exacerbation but not appropriate. This work can range from peer-reviewed original articles to review articles, editorials, and opinion articles. COPD causes significant morbidity and mortality, and is frequently placed in the top four leading causes of death worldwide . The smoking cessation and respiratory rehabilitation plan should be evaluated. There are several diagnostic tools that can be used to assess an exacerbation and its severity, which will in turn guide treatment, and prognostic scores should be used to predict the risk of future exacerbations. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other con… Patients with mild exacerbations should be re-assessed after three months, with spirometry and a re-evaluation of the GOLD degree and, when appropriate, reclassification. They may need to seek medical help at a hospital. Criner, J. Bourbeau, R.L. Less adverse effects were observed in group 1. CD010257. The GOLD 2018 document1 does not recommend that CRP be used routinely but state that several studies have suggested that procalcitonin-guided antibiotic treatment reduces antibiotic exposure and side effects with the same clinical efficacy. A decision tree to assess short-term mortality after an emergency department visit for an exacerbation of COPD: a cohort study. In Portugal, and although hospitalizations due to COPD between 2009 and 2016 have decreased by 8%, they still represented 8049 hospitalized patients in 2016. Appropriate management of COPD exacerbations presents a clinical challenge and, in order to guide therapy, it is important to identify the underlying cause; however, this is not possible in about a third of severe COPD exacerbations. Global Initiative for Chronic Obstructive Lung Disease. Study design: Randomized, controlled, open-label trial. Abdallah, Z. Hammouda. COPD: How can evidence from randomised controlled trials... Noninvasive ventilation during weaning from prolonged... Creative Commons Attribution 4.0 International License. Int J Chron Obstruct Pulmon Dis, 10 (2015), pp. Appropriate management of COPD exacerbations presents a clinical challenge and, in order to guide therapy, it is important to identify the underlying cause; however, this is not possible in about a third of severe COPD exacerbations. Dual therapy strategies for COPD: the scientific rationale for LAMA + LABA. Eosinophilia, frequent exacerbations, and steroid response in chronic obstructive pulmonary disease. Albuterol 2.5 mg plus ipratropium 350 mcg nebulizer treatment STAT O2 to maintain Spo2 of 90% Arterial blood gases in am CBC and differential now Basic metabolic panel now CXR … Protocol for management of COPD exacerbation in primary care. Infectious exacerbations are characterized by increases in volume and purulence of the sputum associated with aggravated dyspnea and should be treated with antibiotics.1,8, The assessment of an exacerbation and its severity is based on the patient's medical history,1,6 e.g., airflow limitation, duration of worsening of symptoms and number of previous episodes (total/hospitalizations). Knol, R. Lutter, H.M. Jansen. We performed a randomised, controlled trial in patients with acute exacerbations of COPD, comparing C-reactive protein (CRP)-guided antibiotic treatment to patient reported symptoms in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, in order to show a reduction in antibiotic prescription.Patients hospitalised with acute exacerbations of COPD were randomised to … You can't change the severity of your disease, but you can take steps to … Chavaillon, C. Maurer, M. Zureik, J. Piquet. If the patient remains hypoxemic, long-term supplemental oxygen therapy may be required.1 Also, patients should be given clear instructions about when and how to stop their corticosteroid treatment.1,8 Concerning the need for individualized care, a Canadian study in which the patients were offered a post discharge phone call, a home visit and continued care concluded that although there was no reduction in 30- and 90-day readmission rates, a decrease in 90-day total mortality was seen. 48-55. Pulmonology (previously Revista Portuguesa de Pneumologia) is the official journal of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia/SPP). During the follow-up consultation (three months for moderate exacerbations and 4–6 weeks for severe exacerbations), spirometry and arterial blood gases should be measured. During a chronic obstructive pulmonary disease (COPD) exacerbation, a person experiences a sudden worsening of their symptoms. M. Bafadhel, S. McKenna, S. Terry, V. Mistry, C. Reid, P. Haldar. T.W. Puhan. Corticosteroids seem to be beneficial to the whole population in terms of treatment success rate.37, Some studies suggest that corticosteroids may be less efficacious in treating acute COPD exacerbations in patients with lower levels of blood eosinophils.15,38, As for methylxanthines in the management of COPD exacerbations, current evidence does not support their use, given that the possible beneficial effects in lung function and clinical endpoints are modest and inconsistent, whilst adverse events are significant.1,4,6,31 Intravenous methylxanthines (theophylline or aminophylline) may be considered second-line therapy and used as an add-on when there is insufficient response. Infection in COPD exacerbation et al ICU ) 1 and have a very severe exacerbations require to... F. Neukirch, D. Perrotin, 186 ( 2012 ), pp paper was provided by Portugal! Trials... 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