Treatment setting for a COPD exacerbation

COPD exacerbations can often be managed in the community without referral or admission to hospital.

Specific indications for hospital admission of a patient with an exacerbation of COPD are listed in Indications for hospitalisation for a COPD exacerbation.

Figure 1. Indications for hospitalisation for a COPD exacerbation. [NB1]
  • inadequate response to ambulatory management
  • inability to walk between rooms (in patients who are usually mobile)
  • inability to eat or sleep because of dyspnoea
  • inability to manage at home, even with home-care resources
  • high-risk comorbidity—pulmonary (eg pneumonia) or nonpulmonary
  • altered mental status suggestive of hypercapnia
  • worsening hypoxaemia or cor pulmonale
  • worsening or new-onset central cyanosis
  • newly occurring arrhythmia
  • development of peripheral oedema
  • haemodynamic instability
  • acute respiratory failure
  • onset of new physical signs (eg peripheral oedema).
Note:

COPD = chronic obstructive pulmonary disease

NB1: If the patient has an advance care plan, consider the patient’s preference regarding treatment and hospitalisation in the event of an exacerbation.

Adapted with permission from: Yang I, Dabscheck E, George J, Jenkins S, McDonald C, McDonald V, et al. The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2020, Version 2.61. Milton, QLD: Lung Foundation Australia; February 2020. [URL]