Drug therapy

β₂-agonists and anticholinergics, with or without corticosteroids, should be started concurrently with O₂ therapy with the aim of reversing airway obstruction.

Short-acting β₂-agonists are the cornerstone of drug therapy for acute exacerbations. The most widely used drug is Ventolin™.  In life-threatening exacerbations, β₂-agonists may be given continuously via nebuliser until improvement occurs.

Oral corticosteroids should begin immediately for all but mild exacerbations. They shorten recovery time and reduce the risk of relapse. The recommended option is prednisolone, 30-40mg per day for 7-10 days. Inhaled corticosteroids have no role in the treatment of acute exacerbations.

Antibiotics are recommended for exacerbations in patients with purulent sputum. Some physicians give antibiotics empirically for change in sputum colour or for nonspecific chest X-ray abnormalities. Routine cultures and Gram stains are not necessary before treatment unless an unusual or resistant organism is suspected (e.g. hospitalised, institutionalised, or immunosuppressed patients). Choice of drug is dictated by local patterns of bacterial sensitivity and patient history.

Reference

1. Global Initiative for chronic obstructive lung disease: Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org