COPD Exacerbations & Antibiotics

Adapted from Molly Graham's August 17th 2016 Grand Rounds presentation.

Treatment of acute COPD exacerbation

Acute exacerbations are characterized by sustained (48 hours or more) worsening of shortness of breath and coughing, with or without sputum. The most common cause is a viral or bacterial infection. 

• Therapy with short-acting beta2 agonists and anticholinergic bronchodilators
• Oral corticosteroids (e.g., prednisone 25-50 mg/day) for less than two weeks in most moderate to severe COPD patients. A dose of 30–40 mg of prednisone equivalent per day has been used in practice.
• Antibiotic use is based on risk factors; evidence shows that antibiotics improve outcomes in those with critically ill COPD exacerbations, however mild or moderate exacerbations are not improved by antibiotics. 

Risk Factors

• Age >65
• FEV1 <50 % of predicted
• > 4 exacerbations / year
• Ischemic heart disease
• Use of home oxygen
• Chronic oral steroid use
• Antibiotic use in the past 3 months. 

Source: British Columbia COPD Guidelines

Common Co-morbidities in COPD

Procalcitonin Levels

Peptide inflammatory marker currently being evaluated for use as a POC marker for inflammatory and infectious disease. 

Evaluation of COPD exacerbations with procalcitonin can decrease antibiotic use.

A PCT <0.1ng/mL indicates patient outcomes will not be improved with antibiotics.

Procalcitonin for COPD.pdf
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