Treating and preventing acute exacerbations of COPD

Umur S. Hatipoglu; Loutfi S. Aboussouan

doi:10.3949/ccjm.83a.14188

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TABLE 1

Antibiotic choice for COPD exacerbations

Clinical presentation	Risk factors	Suggested antibiotic
Uncomplicated exacerbation (determined by risk factors)	Age < 65 FEV₁ > 50% No cardiac disease < 3 exacerbations per year	Macrolide or 2nd- or 3rd-generation cephalosporin
Complicated exacerbation	Age ≥ 65 FEV₁ ≤ 50% Comorbidity ≥ 3 exacerbations per year	Respiratory fluoroquinolone or Combined amoxicillin and clavulanic acid
*At risk for Pseudomonas* infection**	FEV₁ ≤ 50% Known infection with Pseudomonas Bronchiectasis Prior antibiotic and steroid use	Antipseudomonal fluoroquinolone

Information based on Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med 2008; 359:2355–2365 and Anzueto A. Primary care management of chronic obstructive pulmonary disease to reduce exacerbations and their consequences. Am J Med Sci 2010; 340:309–318.

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TABLE 2

Preventing COPD exacerbations

Inhaled therapy
Long-acting beta-2 agonist + inhaled corticosteroid
Long-acting antimuscarinic agent
Long-acting antimuscarinic agent + long-acting beta-2 agonist

Phosphodiesterase-4 inhibitors
Roflumilast

Mucolytics
N-acetylcysteine 600 mg oral twice daily
Carbocysteine (not available in United States)

Antibiotics
Azithromycin 250 mg daily or 500 mg 3 times weekly

Pulmonary rehabilitation

Vaccinations
Influenza
Pneumococcal

Smoking cessation
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