Infective Exacerbation of COPD

NB: CONSIDER POSSIBILITY OF COVID-19 IN ALL PATIENTS WITH INFLUENZA-LIKE ILLNESS

ANTIBIOTIC CHOICES HAVE BEEN ALTERED DURING THE COVID-19 PANDEMIC. USE MACROLIDES AND QUINOLONES WITH CAUTION DUE TO RISK OF QTc PROLONGATION, WHICH MAY COMPLICATE POTENTIAL MYOCARDIAL DISEASE IN THESE PATIENTS

Clinical features

Sustained worsening of patient’s symptoms from their usual stable state, beyond normal day-to-day variations, and acute in onset. May include:

• Worsening breathlessness
• Cough
• Increased sputum production
• Change in sputum colour

Investigations

• Viral throat swab (unless discharged from A&E)
• Sputum, if purulent, for culture
• Blood culture if febrile

Infection control

Isolation with droplet precautions if the patient has cough or coryzal symptoms

Treatment

Treat with antibacterials if sputum is more purulent

If CXR shows consolidation treat instead as for PNEUMONIA and reconsider need for steroids

Review treatment with results of Microbiology investigations

A positive viral throat swab may allow you to stop antibacterials

1st choice