Successful management of AECOPD in either the inpatient or outpatient setting requires attention to several key issues, which include: (9,10)
Pharmacologically, the major components in managing AECOPD include the use of short-acting bronchodilators (beta-2-adrenergic agonists and anticholinergic agents), systemic corticosteroids and antibiotics.
Meta-analyses have shown no difference in the efficacy of delivering the bronchodilator therapy via a nebuliser over inhalation via a spacer device for patients with AECOPD.
The role of methylxanthines (aminophylline and theophylline) in the treatment of AECOPD remains controversial and in general, these agents are not recommended.
16,17) Use of systemic corticosteroid therapy for hospitalised AECOPD patients accelerates the rate of lung function improvement and improves the sensation of dyspnoea over the first 72 hours of treatment.
Patients experiencing AECOPD with clinical signs of airway infection (such as increased sputum volume and change of colour of sputum and/or fever) may benefit from antibiotic treatment.
A recent Cochrane review has also supported the use of antibiotic therapy for patients who are moderately or severely ill with AECOPD with increased cough and sputum purulence.
There is little evidence supporting the use of mucoactive agents such as N-acetylcysteine in AECOPD.
Furthermore, length of hospital stay and complications associated with the treatment of AECOPD are reduced in the NPPV treatment group compared with medical treatment alone.