East Sussex - Better Together

COPD - Management of Exacerbations

If an infective cause is implicated in an exacerbation, it is usually viral. Therefore, routine prescribing of antibiotics for COPD exacerbations is not warranted.

Green sputum alone is not consistent with bacterial infection and occurs due to inflammation.

Prescribe prednisolone 30mg for 7-14 days and advise patient to return if not better.

Only reduce prednisolone dose slowly if patient:

• has received repeated courses (especially if taken for longer than 3 weeks)
• has other factors pre-disposing to adrenal suppression (eg, Addison’s disease)

Oral antibiotics

Antibiotics should be prescribed if there are 2 out of the following 3 criteria present:

• Increased breathlessness
• Increased sputum production
• Increased sputum purulence

Follow local antimicrobial guidelines

Rescue packs

If two or more exacerbations in past 12 months consider rescue pack.

  • Ensure patient is clear when and how to use
  • Include in written self-management plan
  • Advice to notify GP practice when treatment started

For most patients:
- Prednisolone 5mg tablets; six tablets daily for seven days; quantity 42

  • First Line Drugs
  • Second Line Drugs
  • Specialist Initiated Drugs
  • Specialist Only Drugs
  • Mixed Status