Guidelines
Acute Exacerbation of COPD (AECOPD)

Acute Exacerbation of COPD (AECOPD)

Microbiology

  • FEV1 <35%
  • Systemic steroid use (≥10mg oral prednisolone x at least 2 weeks)
  • Bronchiectasis
  • Recent Abx use
  • Recent hospitalization
  • Prior respiratory cultures with Pseudomonas or Enterobacteriaceae

Clinical Considerations

IV antibiotics should only be used if the patient cannot tolerate PO

Procalcitonin can be useful in determining which patients are least likely to benefit from abx and for which abx can SAFELY be discontinued (esp. for mild-moderate AECOPD)

  • Dyspnea + sputum purulence + sputum volume all increased
  • Sputum purulence + (dyspnea or increased sputum volume) increased above baseline

Treatment

Risk Factors for Pseudomonas and Enterobacteriaceae:

  • FEV1 <35%
  • Systemic steroid use (≥10mg oral prednisolone x at least 2 weeks)
  • Bronchiectasis
  • Recent Abx use
  • Recent hospitalization
  • Prior respiratory cultures with Pseudomonas or Enterobacteriaceae

Severe exacerbation defined as:

  • AMS,
  • ICU care, OR
  • Need for mechanical ventilation, including NIMV

Risk Factors for Pseudomonas and Enterobacteriaceae:

  • FEV1 <35%
  • Systemic steroid use (≥10mg oral prednisolone x at least 2 weeks)
  • Bronchiectasis
  • Recent Abx use
  • Recent hospitalization
  • Prior respiratory cultures with Pseudomonas or Enterobacteriaceae