ABSTRACT

COPD exacerbations according to GOLD 2020

The recommendations of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) for 2020 define a COPD exacerbation as an acute worsening of lung function leading to a change in treatment. Because the diagnosis of a COPD exacerbation is clinical, symptoms and signs are non-specific and most COPD patients have comorbidities, it is important to exclude other causes that may present in a similar way. The differential diagnosis should include heart failure, atrial fibrillation, pneumothorax, pleural effusion, pulmonary embolism and pneumonia. Medications used include short-acting bronchodilators (beta-2-mimetics alone or combined with anticholinergics) delivered via a nebuliser or a metered-dosed inhaler (MDI), preferably with a spacer, antibiotics for 5-7 days according to local protocols (use of antibiotics is guided mainly by the production of sputum and presence of pus) and short-term oral steroids (prednisone or prednisolone 40 mg for 5 days). Long-acting bronchodilators with or without an inhaled steroid should be continued throughout the exacerbation.