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• Anticholinergics
• B2 Agonists
Levalbuterol
Albuterol
Pirbuterol
Terbutaline
LABA Inhaler (mcg) Oral DOA (hr)
Salmeterol 25-50 12
Formeterol
Bambuterol 10-20 mg od
Indacarterol
• Side effects: tremor and tachycardia
SAA Inhaler For nebuliser DOA (HR)
mg/ml
Ipratropium 20,40 0.25-0.5 6-8
MDI
Oxitropium 100 1.5 7-9
MDI
LAA Inhaler Oral DOA (hr)
(mcg)
Tiotropium 18 DPI 24
Signs of Severity
• The Global Initiative for COPD(GOLD), a report produced
by the National Heart, Lung, and Blood Institute (NHLBI)
and the WHO, defines an exacerbation of COPD as an
acute increase in symptoms beyond normal day-to-day
variation. This generally includes an acute increase in
one or more of the following cardinal symptoms:
1. Cough increases in frequency and severity
2. Sputum production increases in volume and/or changes
character
3. Dyspnea increases
• Haemophilus influenzae
• Moraxella catarrhalis
• Streptococcus pneumoniae
• Pseudomonas aeruginosa
• Enterobacteriaceae
• Haemophilus parainfluenzae
• Staphylococcus aureus
(Note: Despite the frequent implication of bacterial
infection, chronic suppressive or "rotating" antibiotics are
not beneficial in patients with COPD and is not
recommended.)
Most common cause is viral upper RTI
American Thoracic Society/European Respiratory Society (ATS/ERS)
• Inadequate response of symptoms to outpatient management
• Marked increase in dyspnea
• Inability to eat or sleep due to symptoms
• Worsening hypoxemia
• Worsening hypercapnia
• Changes in mental status
• Inability to care for oneself (ie, lack of home support)
• Uncertain diagnosis
• High risk comorbidities including pneumonia, cardiac arrhythmia,
heart failure, diabetes mellitus, renal failure, or liver failure