D3.2 Exacerbations and crises

Detailed discussion of the management of exacerbations is found in section X.

For severe exacerbations there is evidence for the use of bronchodilators, antibiotics, systemic corticosteroids and supplemental oxygen (if patients are hypoxaemic). Selected patients may benefit from early intervention with these agents according to a predetermined plan developed by a GP or respiratory specialist. Some patients can be instructed to start using a “crisis medication pack” while awaiting medical review. They may also be instructed to contact a particular member of the multidisciplinary care team as part of their overall care plan.

Controlled trials are required to document the efficacy of self-management plans in patients with stable COPD, but, drawing on the success of asthma action plans, education of patients with COPD in self-management is recommended. Written plans are usually required to complement such interventions (see examples at https://lungfoundation.com.au/resources/?user_category=32&search=copd%20action%20plan).

A randomised controlled trial of 577 subjects with mild COPD, obtained from UK primary care COPD registers of 71 general practices evaluated a telephone health coaching programme which included the provision of a pedometer, written educational documents, diary, inhaler use education and encouragement of medication adherence (Jolly 2018). Most potential subjects did not respond to an invitation to participate. While there was no benefit on the primary outcome of quality of life as measured by the St George Respiratory Questionnaire, nor the secondary outcomes of anxiety and depression, other secondary outcomes of self-reported physical activity and inhaler usage did improve [evidence level II].