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Written Plans for COPD Exacerbation Treatment


WebMD Medical Reference from the COPD Foundation

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You and your doctor should create a written plan of action for acute exacerbations. This plan may include:

  • Using more of your bronchodilators and using them more often
  • Adding an inhaled steroid to your routine or increasing the dose if you are already taking one
  • Using antibiotics
  • Using a brief “burst” of oral steroids
  • Eating properly and drinking plenty of water
  • Using oxygen or turning up your oxygen

After you have met with your doctor and you understand your action plan, you can probably manage some exacerbations at home. However, some exacerbations may be so severe that you need to be seen by your doctor. Or you may need to visit an emergency room or be admitted to the hospital, perhaps even the Intensive Care Unit.

In addition, many patients with exacerbations may need a chest exam by their doctor. They may also need an X-ray to rule out pneumonia. And they may need to have their arterial blood gases tested to check oxygen and carbon dioxide levels in the blood. These may all need to be done at the start of an acute exacerbation. These tests and exam will help assess the severity of the episode.

There are no definite rules about seeking medical help. But here are some guidelines you can discuss with your health care provider:

1. If you don’t have a home action plan, call your health care provider within 24 hours if you notice one or more of the following symptoms:

  • Shortness of breath or wheezing does not stop or decrease with inhaled bronchodilator treatments. Or it requires more frequent use of an inhaler or nebulizer.
  • Change in color, thickness, odor or amount of mucus
  • New or increased ankle swelling that lasts even after a night of sleeping with your feet up
  • You awaken short of breath more than once a night
  • Increased fatigue that lasts more than one day
  • Persistent fever

2. Go immediately to the emergency room or call 911 when you are having the following:

  • Disorientation, confusion, slurring of speech or sleepiness during an acute lung infection
  • Loss of alertness or two or more of the following:
    • Marked increase in intensity of symptoms, such as sudden shortness of breath at rest
    • Overuse of upper chest and neck muscles to be able to breathe
    • Large increase in heart rate
    • Large increase or decrease in respiratory rate
  • Any severe shortness of breath or chest pain, or other severe symptoms, especially if they are new

There are many helpful measures you can do at home to treat signs and symptoms. And there are also actions that should be avoided when you have a new exacerbation:

  • Do not take extra doses of theophylline
  • Do not take codeine or any other cough suppressant
  • Do not use over-the-counter nasal sprays for more than three days
  • Do not smoke
  • Do not wait any longer than 24 hours to contact your doctor if symptoms continue

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