Summary: Based on the European Respiratory Society/American Thoracic Society guidelines on the management and prevention of COPD exacerbations, “for ambulatory patients with an exacerbation of COPD we suggest a short course of oral corticosteroids. For ambulatory patients with an exacerbation of COPD, we suggest the administration of antibiotics. For patients who are hospitalized with a COPD exacerbation, we suggest the administration of oral corticosteroids rather than intravenous corticosteroids if gastrointestinal access and function are intact. For patients who are hospitalized with a COPD exacerbation associated with acute or acute-on-chronic respiratory failure, we recommend the use of noninvasive mechanical ventilation. For patients with a COPD exacerbation who present to the emergency department or hospital, we suggest a home-based management program. For patients who are hospitalized with a COPD exacerbation, we suggest the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge. For patients who are hospitalized with a COPD exacerbation, we suggest not initiating pulmonary rehabilitation during hospitalization.
For patients who have COPD with moderate or severe airflow obstruction and exacerbations despite optimal inhaled therapy, we suggest treatment with an oral mucolytic agent to prevent future exacerbations. In patients who have COPD with moderate or severe airflow obstruction and a history of one or more COPD exacerbations during the previous year, we recommend that a LAMA be prescribed in preference to LABA monotherapy to prevent future exacerbations. In patients who have COPD with severe or very severe airflow obstruction, symptoms of chronic bronchitis and exacerbations despite optimal inhaled therapy, we suggest treatment with roflumilast to prevent future exacerbations. Fluoroquinolone therapy is not suggested as treatment for the sole purpose of preventing future COPD exacerbations. For patients who have COPD with moderate to very severe airflow obstruction and exacerbations despite optimal inhaled therapy, we suggest treatment with a macrolide antibiotic to prevent future exacerbations.”