What are the treatments for exacerbations of chronic obstructive pulmonary disease?
The general principles of treatment are to increase the inhalers that open up the airways (bronchodilators) and to take an oral steroid (usually prednisolone). Antibiotics should only be used if there is any evidence of a bacterial infection.
You should act quickly as soon as you realise that your symptoms are getting any worse. Most people with COPD are given a treatment plan to follow if the symptoms get any worse. This often includes having a supply of steroid tablets (prednisolone) to start as soon as any increased breathlessness starts to affect your activities. You will also often be given an antibiotic to take as soon as your phlegm (sputum) changes colour.
However, it's very important to see your doctor if your symptoms don't get better quickly, if your symptoms are really bad or if you have any concerns.
Treatment at home
The treatment for an acute flare-up (exacerbation) at home includes:
- Increasing the dose of short-acting inhalers to help open up the airways (bronchodilators). Spacer devices help to get more of the inhaler down into your airways and so make the treatment more effective. Inhalers used with a spacer device are as effective as using a nebuliser.
- A 7-14 day course of an oral steroid (usually prednisolone) should be used if there is a significant increase in breathlessness unless there's a reason why you can't be prescribed an oral steroid.
- You should only take a course of an antibiotic medicine if your sputum changes colour or if your doctor thinks you may have a chest infection. A sample of your sputum is usually sent to the hospital microbiology laboratory to check whether you are taking the right antibiotic for your infection.
- More severe exacerbations of COPD may need treatment with oxygen.
Admission to hospital
If your symptoms are very severe, or if treatments at home are not working well enough, you may need to be admitted to hospital. In hospital, you can be monitored more closely.
- Often the same medicines are given to you but at higher doses or in a different form.
- Tests can be performed with the results very quickly available, such as:
- A chest X-ray.
- Blood tests to measure how much oxygen there is in your blood (arterial blood gases).
- Chest physiotherapy can be started to help you clear the sputum from your chest and help you to breathe more easily.
- If you are very breathless it may be impossible to use your inhaler. Nebulisers are machines that turn the bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece.
- Although nebulisers are usually no more effective than normal inhalers used with a spacer device, they are useful if you are very tired with the increased effort of breathing.
- Oxygen treatment:
- You may need oxygen to help you breathe. Sometimes a special machine (either a bi-level positive airway pressure (BiPAP) machine or a continuous positive airway pressure (CPAP) machine) is used to help you breathe.
- This is called non-invasive ventilation (NIV). It consists of a close-fitting facemask and drives oxygen into your lungs, forcing the airways to open.
- In very severe cases, you might need more help with breathing, in an intensive care unit (ICU). A tube can be put into your windpipe and connected to a machine that 'breathes' for you (a ventilator).
How can you reduce the risk of further exacerbations?
It is really important to reduce your risk of having any further flare-ups (exacerbations). Exacerbations can make you very unwell and frequent exacerbations can also make your usual everyday symptoms get worse even when you're not having an exacerbation. The risk of having any further exacerbations can be reduced by:
- Controlling your COPD symptoms as best you can. This includes:
- Not smoking.
- Taking your medications as directed by your doctor or nurse.
- Attending regular check-ups to make sure your COPD is well controlled. See separate leaflet called Chronic Obstructive Pulmonary Disease for further information.
- It is very important to have the recommended vaccinations (flu (influenza) vaccination and pneumococcal vaccination) to help reduce the risk of these infections.
Further reading and references
Chronic obstructive pulmonary disease; NICE Clinical Guideline (June 2010)
Global Strategy for the Diagnosis, Management and Prevention of COPD; Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2017
Chronic obstructive pulmonary disease; NICE CKS, September 2015 (UK access only)
BTS Guidelines for Home Oxygen Use in Adults; British Thoracic Society and BTS Home Oxygen Guideline Group (2015)
Hi, I'm taking prednisolone for a chest infection. I think they are helping with my breathing but I'm feeling a bit shaky and nauseous. Has anyone else experienced this. Don't want to stop taking...susan32836
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