Supportive Therapy
Hydration
- Maintain adequate hydration to prevent excessive mucus viscosity
Nutritional Programs
- There are no direct or measurable effects on lung function in treating malnutrition but subjective relief and objective improvement in strength and exercise performance do occur
- Dietary supplementation should be considered if patient is malnourished (body weight <85% of ideal) or experiencing early satiety
- Advise patient to obtain nutritional counseling to reduce weight if obese
Oxygen Therapy
- Cornerstone of COPD exacerbation treatment
- Low-flow O2 should be administered if hypoxemia is present
- Excess use of O2 should be avoided as this may lead to progressive hypercapnia, either by decreasing hypoxic ventilatory drive or by worsening ventilation-perfusion mismatching within the lung
- Once O2 therapy is initiated, arterial blood gas should be monitored 30-60 minutes later to ensure satisfactory oxygenation without acidosis or CO2 retention
- Goal of supplemental O2 therapy should be arterial oxygen partial pressure at or just above 60 mmHg
Noninvasive Positive Pressure Ventilation
- Frequently used for inpatient management of AECB patients who are significantly hypoxemic or with a serum pH <7.3
- Improves ventilation and lower pCO2 levels and may be a means of avoiding intubation
- Decreases hospital or intensive care unit length of stay and morbidity