- Beta2-agonists and anticholinergics are the initial bronchodilators
- Prednisone 1 mg/kg/day (up to 60 mg/day) or steroid equivalent for moderate-severe exacerbations x 5-7 days
- Antibiotics indicated for moderate-severe exacerbations with pulmonary infiltrate or sputum purulence
–procalcitonin level >0.25 ng/mL supports antibiotic use
- Noninvasive positive pressure ventilation (NPPV) for acute respiratory failure
–Consider for pH<7.35 and PaCO2>45
- Mechanical ventilation indicated for:
–Hemodynamic instability
–Failure of NPPV
–Decreased level of consciousness or severe agitation
–Life-threatening hypoxemia
Reference:
Available at http://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf