Table 3: Recommendations by Professional Societies for Management of Acute Exacerbations of COPD

Table 3:
*Recommendations by Professional Societies for Management of Acute Exacerbations of COPD**
Bronchodilators
American Thoracic Society	European Respiratory Society	British Thoracic Society	Global Initiative for Chronic Obstructive Lung Disease
Recommended: Beta₂-agonists +/- anticholinergics; IV aminophylline if inadequate response	Recommended: Beta₂-agonists +/- anticholinergics; methylxanthines if needed as second line in severe exacerbations	Recommended: Beta₂-agonists +/- anticholinergics; IV aminophylline if inadequate response	Recommended: Beta₂-agonist dose increase +/- anticholinergics +/- IV aminophylline depending on disease severity
Corticosteroids
Oral or systemic	Oral or systemic empirically	7-14 days of systemic steroids	Systemic steroids
Antibiotics
Narrow-spectrum antibiotic; broad spectrum if no response	Inexpensive antibiotic empirically for 7-14 days; if ineffective, choice guided by sputum culture	Common oral antibiotics usually adequate Broader spectrum if no response or if more severe exacerbation.	Empirically with increased sputum volume and purulence based on local sensitivity patterns to usual pathogens
Oxygen Therapy
Raise PaO₂> 60 mm Hg	Keep SaO₂> 90% and/or PaO₂> 60 mm Hg. Avoid PaCO₂ rise by > 10 mm Hg or pH drop to < 7.25	Raise PaO₂ > 50 mm Hg while avoiding pH < 7.26	Keep SaO₂ > 90% and PaO₂ > 60 mm Hg
Ventillatory Support
NIPPV or invasive mechanical ventilation based on criteria	NIPPV in appropriate patients	NIPPV or invasive mechanical ventilation if pH < 7.26 with rising PaCO₂ despite controlled oxygen therapy	NIPPV or invasive mechanical ventilation based on selection and exclusion criteria.
Chest Physiotherapy
Only if sputum volume is > 25 ml/day	Help in clearance of secretions	Not recommended	May be beneficial in certain circumstances
*Abbreviations for professional societies are in Table 1 footnote. IV-Intravenous NIPPV-Noninvasive positive pressure ventilation

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