Management of Acute Exacerbation of COPD (AECOPD)

COPD Bundle

Patient presents to ED / AMAU following GP / self referral
Patient assessed by ED/AMAU Officer and routine investigations ordered CXR ECG ABG Bloods (CBC, CRP, U+E, LFTS)

On presentation

Administration of humidified O2 (FiO2 2L via nasal cannula or 28% via mask)
Maintain>88% SaO2 < 92%

Within 30 min

Administer nebulised Beta 2 agonists and anticholinergics
Check arterial blood gas and repeat if FiO2 increase is required. If in respiratory failure with pH < 7.35 consider initiation of non- invasive ventilation/ transfer to appropriate Dept.

Within 4 hrs

Review laboratory results

Review CXR results

Administer antibiotics PO

Oral prednisone 40 mg (30 mg if 60kg or less) if wheezy or elevated inflammatory markers

PO Amoxycillin or Clarithromycin or doxycycline If infiltrate, treat as pneumonia

Consider COPD Outreach

TED stockings or LMWH for prophylaxis (if admitted)

Refer to Respiratory Team/Nurse within 24hrs of admission