COPD Exacerbation
Source: GOLD 2025–2026 · Last reviewed: Jul 2026
1
Initial Action
Assess severity. Controlled oxygen (target SpO₂ 88–92%, adapt to patient baseline). Short-acting bronchodilators (SABA + SAMA).
2
Decision
Exacerbation severity?
Mild
Bronchodilator only, outpatient
Moderate
+ systemic corticosteroid ~5 days
Severe
Inpatient, controlled O₂, consider early NIV
Antibiotic Criteria (not for every exacerbation)
Increased sputum purulenceEvidence of bacterial infectionRequiring ventilatory support
3
Decision
Persistent hypercapnic respiratory failure despite optimal NIV / contraindication to NIV?
Yes → intubation & invasive mechanical ventilation.
Adjust saturation target to patient baseline (chronic CO₂ retention risk) and local hospital protocol.