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Medical Therapy for COPD

Consider Oxygen Therapy if known COPD 94% or above
or if known or at risk of type 2 respiratory failure 88-92%

Blood Gas pH <7.35 pCO2>6.0 (If pO2 >7.3 reduce oxygen flow)

Yes

Consider NIV. Complet Prescription Chart for Acute NIV

  • Avoid High flow O2
  • O2 via Nasal Cannula (Flow rate 1-2 l/miN, if >2 use venturi mask)
  • Alternately use 24-28% venturi mask
  • Minimum Flow Rate to maintain O2 Sats 88/ 92% OR specify target from patient Alert Card
  • Nebulisers administered using air
  • Supplemental O2 delivered using nasal cannula underneath the nebuliser mask at the lowest flow rate required
  • Minimum Flow Rate to maintain O2 Sats 88/92%

No

O2 to maintain Sats 94% - 98%

  • Nebulised Broncodilators
  • Salbutamol Nebs 2.5-5mg OR Terbutaline Nebs 5-10mg
  • Ipratropium Bromide 500mcg (nebulised QDS)

Administer nebuliser using oxygen

Once nebuliser complete revert back to controlled oxygen

Patient unable to swallow or history of vomiting?

Yes

IV Hydrocprtisone 200mg via slow IV bolus

If NBM or vomiting continues further doses of
hydrocortisone are required (50-100mg four
times a day, but dependent on patient/clinician).

No

Oral Prednisolone 30mg once daily in the morning (7-14 days)

Antibiotics indicated if:

  • Increase in sputum volume
  • Increase in purulence of sputum
  • Dyspnoea

Yes

Allergic to Doxycyline or Tetracyclines?
Yes - Check next allergy
No - Doxycyline 100mg PO BD (Unless received in last 2 weeks)
Check appropriateness of antibiotic treatment against laboratory culture and sensitivities when available

Allergic to Amoxycillin or Penicillins?
Yes - Check next allergy
No - Amoxycillin 500mg PO (Unless received in last 2 weeks)
Check appropriateness of antibiotic treatment against laboratory culture and sensitivities when available

Allergic to Clarithromycin?
Yes - See Microbiologist
No - Clarithromycin 500mg PO (Unless received in last 2 weks)
Check appropriateness of antibiotic treatment against laboratory culture and sensitivities when available

Discuss with Microbiologist

Patient responding to bronchodilators and steroids?

Yes

Follow Monitoring Recovery and Early Assisted Discharge Pathway

Monitoring Recovery and EAD Pathway

No

  • Discuss with Senior Doctor (Reg level)
  • Aminophylline indicated?

Is patient on Oral Theophylline or Oral Aminophylline preparations?

Yes

Omit loading dose

No

Commence IVAminophylline

Loading Dose: 5mg/kg IV over 20 minutes

Maintenance dose: 0.5mg/kg/hr

If still unstable consider ceiling treatment