New GOLD Guidelines for COPD Exacerbations

by Joseph Esherick, M.D., FAAFP, FHM
  • Beta2-agonists and anticholinergics are the initial bronchodilators

  • Prednisone 1 mg/kg/day (up to 60 mg/day) or steroid equivalent for moderate-severe exacerbations x 5-7 days

  • Antibiotics indicated for moderate-severe exacerbations with pulmonary infiltrate or sputum purulence

           –procalcitonin level >0.25 ng/mL supports antibiotic use

  • Noninvasive positive pressure ventilation (NPPV) for acute respiratory failure

           –Consider for pH<7.35 and PaCO2>45

  • Mechanical ventilation indicated for:

           –Hemodynamic instability

           –Failure of NPPV

           –Decreased level of consciousness or severe agitation

           –Life-threatening hypoxemia


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