COPD exacerbation - Revision history

Danbot: Add MedicationDose SMW annotations for corticosteroids (hydrocortisone, methylprednisolone, prednisone); dosing verified per GOLD/ATS guidelines

2026-03-20T16:17:54Z

Add MedicationDose SMW annotations for corticosteroids (hydrocortisone, methylprednisolone, prednisone); dosing verified per GOLD/ATS guidelines

← Older revision		Revision as of 16:17, 20 March 2026
Line 180:		Line 180:
	*Insufficient home support		*Insufficient home support


			<div style="display:none">
			<!-- SMW MedicationDose annotations for COPD exacerbation medications -->
			{{MedicationDose\|drug=Hydrocortisone\|dose=100-125 mg IV q6h x5 days\|route=IV\|context=Corticosteroid (IV option)\|indication=COPD exacerbation}}
			{{MedicationDose\|drug=Methylprednisolone\|dose=125 mg IV daily (1-2 mg/kg)\|route=IV\|context=Corticosteroid (IV option)\|indication=COPD exacerbation\|notes=Use IV only if cannot tolerate PO; equal efficacy oral vs IV}}
			{{MedicationDose\|drug=Prednisone\|dose=60 mg PO x1, then 40 mg PO daily x5 days\|route=PO\|context=Corticosteroid (preferred, oral)\|indication=COPD exacerbation\|notes=5-day course equally effective as longer; taper not required}}
			</div>
	==See Also==		==See Also==
	[[EBQ:NIPPV in COPD]]		[[EBQ:NIPPV in COPD]]

Danbot: Remove incorrect Cefuroxime 400mg AntibioticDose entries (dose was from Cefditoren data, not Cefuroxime)

2026-03-20T12:15:13Z

Remove incorrect Cefuroxime 400mg AntibioticDose entries (dose was from Cefditoren data, not Cefuroxime)

← Older revision		Revision as of 12:15, 20 March 2026
Line 154:		Line 154:
	*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefuroxime\|dose=400 mg PO bid x10 days\|context=Chronic Bronchitis, Acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}


Line 161:		Line 160:
	*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefuroxime\|dose=400 mg PO bid x10 days\|context=Chronic Bronchitis, Acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}


Line 168:		Line 166:
	*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefuroxime\|dose=400 mg PO bid x10 days\|context=Chronic Bronchitis, Acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}

	==Disposition==		==Disposition==

Danbot: Add AntibioticDose entries: Azithromycin, Clarithromycin, Cefpodoxime, Cefuroxime

2026-03-20T10:58:00Z

Add AntibioticDose entries: Azithromycin, Clarithromycin, Cefpodoxime, Cefuroxime

← Older revision		Revision as of 10:58, 20 March 2026
Line 148:		Line 148:
	*Maximize expiratory time by modifying I:E ratio		*Maximize expiratory time by modifying I:E ratio
	*If patient with worsening hypercarbia, may benefit from paradoxically decreasing respiratory rate to improve expiratory time and improve gas exchange		*If patient with worsening hypercarbia, may benefit from paradoxically decreasing respiratory rate to improve expiratory time and improve gas exchange


			===Antibiotic Dosing===
			*{{AntibioticDose\|drug=Azithromycin\|dose=500mg PO x1 on day 1, then 250mg PO q24h x4 days; Alt: 500mg PO q24h x3 days\|context=COPD exacerbation\|disease=COPD exacerbation\|population=Adult}}
			*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}
			*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}
			*{{AntibioticDose\|drug=Cefuroxime\|dose=400 mg PO bid x10 days\|context=Chronic Bronchitis, Acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}

Danbot: Add AntibioticDose entries: Azithromycin, Clarithromycin, Cefpodoxime, Cefuroxime

2026-03-20T10:57:36Z

Add AntibioticDose entries: Azithromycin, Clarithromycin, Cefpodoxime, Cefuroxime

← Older revision		Revision as of 10:57, 20 March 2026
Line 148:		Line 148:
	*Maximize expiratory time by modifying I:E ratio		*Maximize expiratory time by modifying I:E ratio
	*If patient with worsening hypercarbia, may benefit from paradoxically decreasing respiratory rate to improve expiratory time and improve gas exchange		*If patient with worsening hypercarbia, may benefit from paradoxically decreasing respiratory rate to improve expiratory time and improve gas exchange


			===Antibiotic Dosing===
			*{{AntibioticDose\|drug=Azithromycin\|dose=500mg PO x1 on day 1, then 250mg PO q24h x4 days; Alt: 500mg PO q24h x3 days\|context=COPD exacerbation\|disease=COPD exacerbation\|population=Adult}}
			*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}
			*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}
			*{{AntibioticDose\|drug=Cefuroxime\|dose=400 mg PO bid x10 days\|context=Chronic Bronchitis, Acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}

Danbot: Add AntibioticDose entries: Azithromycin, Clarithromycin, Cefpodoxime, Cefuroxime; strip translate tags

2026-03-20T10:57:16Z

Add AntibioticDose entries: Azithromycin, Clarithromycin, Cefpodoxime, Cefuroxime; strip translate tags

← Older revision		Revision as of 10:57, 20 March 2026
Line 148:		Line 148:
	*Maximize expiratory time by modifying I:E ratio		*Maximize expiratory time by modifying I:E ratio
	*If patient with worsening hypercarbia, may benefit from paradoxically decreasing respiratory rate to improve expiratory time and improve gas exchange		*If patient with worsening hypercarbia, may benefit from paradoxically decreasing respiratory rate to improve expiratory time and improve gas exchange


			===Antibiotic Dosing===
			*{{AntibioticDose\|drug=Azithromycin\|dose=500mg PO x1 on day 1, then 250mg PO q24h x4 days; Alt: 500mg PO q24h x3 days\|context=COPD exacerbation\|disease=COPD exacerbation\|population=Adult}}
			*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}
			*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}
			*{{AntibioticDose\|drug=Cefuroxime\|dose=400 mg PO bid x10 days\|context=Chronic Bronchitis, Acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}

	==Disposition==		==Disposition==

Ostermayer: /* Magnesium */

2025-08-15T07:17:32Z

Magnesium

← Older revision		Revision as of 07:17, 15 August 2025
Line 90:		Line 90:
	===[[Magnesium]]===		===[[Magnesium]]===
	*Mechanism: bronchial smooth muscle relaxation		*Mechanism: bronchial smooth muscle relaxation
	*Studies have found that while helpful in asthma, results ~~lack effectiveness~~ for COPD<ref>Shivanthan MC, Rajapakse S. Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials. Ann Thorac Med. 2014 Apr;9(2):77-80.</ref><ref>Jahanian F, Khatir IG, Ahidashti HA, Amirifard S. The Effect of Intravenous Magnesium Sulphate as an Adjuvant in the Treatment of Acute Exacerbations of COPD in the Emergency Department: A Double-Blind Randomized Clinical Trial. Ethiop J Health Sci. 2021 Mar;31(2):267-274. doi: 10.4314/ejhs.v31i2.9. PMID: 34158778; PMCID: PMC8188071.</ref>		*'''Studies have found that while helpful in asthma, results fail to demonstrate positive benefit for COPD'''<ref>Shivanthan MC, Rajapakse S. Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials. Ann Thorac Med. 2014 Apr;9(2):77-80.</ref><ref>Jahanian F, Khatir IG, Ahidashti HA, Amirifard S. The Effect of Intravenous Magnesium Sulphate as an Adjuvant in the Treatment of Acute Exacerbations of COPD in the Emergency Department: A Double-Blind Randomized Clinical Trial. Ethiop J Health Sci. 2021 Mar;31(2):267-274. doi: 10.4314/ejhs.v31i2.9. PMID: 34158778; PMCID: PMC8188071.</ref>

	===[[Antibiotics]]===		===[[Antibiotics]]===

Ostermayer: /* Magnesium */

2025-08-15T07:16:20Z

Magnesium

← Older revision		Revision as of 07:16, 15 August 2025
Line 90:		Line 90:
	===[[Magnesium]]===		===[[Magnesium]]===
	*Mechanism: bronchial smooth muscle relaxation		*Mechanism: bronchial smooth muscle relaxation
	*Studies have found that while helpful in asthma, results ~~are mixed~~ for COPD<ref>Shivanthan MC, Rajapakse S. Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials. Ann Thorac Med. 2014 Apr;9(2):77-80.</ref>		*Studies have found that while helpful in asthma, results lack effectiveness for COPD<ref>Shivanthan MC, Rajapakse S. Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials. Ann Thorac Med. 2014 Apr;9(2):77-80.</ref><ref>Jahanian F, Khatir IG, Ahidashti HA, Amirifard S. The Effect of Intravenous Magnesium Sulphate as an Adjuvant in the Treatment of Acute Exacerbations of COPD in the Emergency Department: A Double-Blind Randomized Clinical Trial. Ethiop J Health Sci. 2021 Mar;31(2):267-274. doi: 10.4314/ejhs.v31i2.9. PMID: 34158778; PMCID: PMC8188071.</ref>

	===[[Antibiotics]]===		===[[Antibiotics]]===
	''Indicated for patients with purulent sputum, increased sputum production, or requiring [[EBQ:NIPPV_in_COPD\|Non Invasive Positive Pressure Ventilation]]<ref>GOLD collaborators</ref> (NNT = 3 to prevent treatment failure and 8 to prevent death)<ref>Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006; 19(2):CD004403.</ref>		''Indicated for patients with purulent sputum, increased sputum production, or requiring [[EBQ:NIPPV_in_COPD\|Non Invasive Positive Pressure Ventilation]]<ref>GOLD collaborators</ref> (NNT = 3 to prevent treatment failure and 8 to prevent death)<ref>Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006; 19(2):CD004403.</ref>

Rossdonaldson1: /* Differential Diagnosis */

2024-04-24T21:06:30Z

Differential Diagnosis

← Older revision		Revision as of 21:06, 24 April 2024
Line 44:		Line 44:

	==Differential Diagnosis==		==Differential Diagnosis==
			{{Wheeze DDX}}
	{{Wheezing DDX}}		{{Wheezing DDX}}

Mceledon83: /* Antibiotics */

2021-12-02T22:58:57Z

Antibiotics

← Older revision		Revision as of 22:58, 2 December 2021
Line 101:		Line 101:
	**[[Azithromycin]] 500mg PO once a day<ref>Rothberg MB, et al: Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA 2010; 303:2035-2042</ref>		**[[Azithromycin]] 500mg PO once a day<ref>Rothberg MB, et al: Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA 2010; 303:2035-2042</ref>
	**[[Doxycycline]] 100mg PO BID		**[[Doxycycline]] 100mg PO BID
	**[[Levofloxacin]] 500mg PO ~~BID~~<ref>Anzueto A, Miravitlles M: Short-course fluoroquinolone therapy in exacerbations of chronic bronchitis and COPD. Respir Med 2010; 104:1396-1403</ref>		**[[Levofloxacin]] 500mg PO Daily<ref>Anzueto A, Miravitlles M: Short-course fluoroquinolone therapy in exacerbations of chronic bronchitis and COPD. Respir Med 2010; 104:1396-1403</ref>

	====Outpatient Unhealthy====		====Outpatient Unhealthy====

Elcatracho: /* Evaluation */

2021-04-19T07:59:31Z

Evaluation

← Older revision		Revision as of 07:59, 19 April 2021
Line 54:		Line 54:
	**For every increase in PaC02 of 10 mmHg, the pH should change by 0.08		**For every increase in PaC02 of 10 mmHg, the pH should change by 0.08
	*Peak flow		*Peak flow
	**<100 indicates severe exacerbation		**<100 L/min indicates severe exacerbation
	*[[CXR]]		*[[CXR]]
	**Consider if concerned for alternative/additional diagnoses (e.g. pneumonia, CHF, pneumothorax, effusions)		**Consider if concerned for alternative/additional diagnoses (e.g. pneumonia, CHF, pneumothorax, effusions)

← Older revision		Revision as of 12:15, 20 March 2026
Line 154:		Line 154:
	*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefuroxime\|dose=400 mg PO bid x10 days\|context=Chronic Bronchitis, Acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}


Line 161:		Line 160:
	*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefuroxime\|dose=400 mg PO bid x10 days\|context=Chronic Bronchitis, Acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}


Line 168:		Line 166:
	*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Clarithromycin\|dose=1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14d\|context=Chronic bronchitis, acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}		*{{AntibioticDose\|drug=Cefpodoxime\|dose=200mg q 12 h for 10 days\|context=Bronchitis (chronic)\|disease=COPD exacerbation\|population=Adult}}
	*{{AntibioticDose\|drug=Cefuroxime\|dose=400 mg PO bid x10 days\|context=Chronic Bronchitis, Acute bacterial exacerbation\|disease=COPD exacerbation\|population=Adult}}

	==Disposition==		==Disposition==