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enseignants",{"title":54,"url":55},{"title":57,"url":58},{"title":186,"group":48,"menu":187},"Produit",[188,189,190,191,192,193,194],{"title":38,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":15,"url":77},{"title":195,"url":10},"Tarification",{"title":197,"group":48,"menu":198},"Mentions légales",[199,200,201,202,203],{"title":197,"url":84},{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":205,"group":48,"menu":206},"Service client",[207,208,209],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},{"content":211,"related":293,"meta":359,"internal":371},{"title":212,"leadIn":213,"category":214,"elements":217,"becomeAnExpert":247,"author":281,"readDuration":291,"readDurationFormatted":292},"Acute COPD exacerbation: outpatient treatment","More than 80% of acute COPD exacerbations are managed in the outpatient setting. This lesson walks you through outpatient treatment for mild and moderate COPD exacerbations—and how to recognize when to escalate care.",{"id":215,"name":216},1,"Course previews",[218,229,234,242],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},329,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Acute COPD Exacerbation Management: Outpatient Treatment of Mild & Moderate COPD Exacerbations","https:\u002F\u002Fyoutu.be\u002FrrUUjrPLkFM",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},22.4,"\u003Cp>\u003Cspan>Managing an acute COPD exacerbation involves several decisions—but one stands out: can this patient be safely managed at home? This lesson walks you through outpatient treatment for mild and moderate COPD exacerbations—what to prescribe, when to add steroids or antibiotics, and when your patient requires hospitalization.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan>In this lesson from our \u003C\u002Fspan>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourses\u002Fcopd-essentials\">\u003Cspan>COPD Essentials course\u003C\u002Fspan>\u003C\u002Fa>\u003Cspan> you'll learn how to:\u003C\u002Fspan>\u003C\u002Fp>\u003Cul>\u003Cli dir=\"ltr\" data-list-item-id=\"ed4092354c995dd1a48e03da474ecbc69\">\u003Cspan>Use short-acting bronchodilators to relieve symptoms of COPD exacerbations\u003C\u002Fspan>\u003C\u002Fli>\u003Cli dir=\"ltr\" data-list-item-id=\"e7e31213b5c415f026504657812a8b295\">\u003Cspan>Prescribe oral glucocorticoids to improve recovery\u003C\u002Fspan>\u003C\u002Fli>\u003Cli dir=\"ltr\" data-list-item-id=\"e2464e90ea55d3d4781f3e9de2ee42b9a\">\u003Cspan>Identify when antibiotics are appropriate in COPD exacerbations\u003C\u002Fspan>\u003C\u002Fli>\u003Cli dir=\"ltr\" data-list-item-id=\"e344e2caccd22360f7af999fc57820b14\">\u003Cspan>Assess exacerbation severity to guide outpatient management\u003C\u002Fspan>\u003C\u002Fli>\u003Cli dir=\"ltr\" data-list-item-id=\"e10f6e4bffc2df4d9033ffa3556c712e1\">\u003Cspan>Identify patients who require hospital-level care\u003C\u002Fspan>\u003C\u002Fli>\u003C\u002Ful>",{"type":235,"data":236},"cta",{"readDurationInSeconds":237,"text":238,"buttonText":239,"buttonUrl":240,"teachIllustration":241},3.466666666666667,"Start the first chapter of our COPD Essentials course for free","Start chapter 1 now","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister?target=%2Fcourses%2Fcopd-essentials","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9e276cff-c252-424b-ab3e-a5580dc2d82f",{"type":230,"data":243},{"readDurationInSeconds":244,"title":245,"text":246},156,"Transcript","\u003Ch3 dir=\"ltr\" id=\"docs-internal-guid-d0740696-7fff-b56e-8aa0-7f375b4d3adc\">\u003Cspan>Outpatient treatment of acute COPD exacerbations\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[00:00]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>In this Medmastery lesson, we'll cover the outpatient management of mild and moderate COPD exacerbations. We'll also cover which patients will need to be sent to the emergency department. More than anything, the severity of an exacerbation dictates if the patient can be treated as an outpatient. More than 80% of exacerbations are managed on an outpatient basis. In this setting, the potential medication used for the management of exacerbations can include short-acting bronchodilators, oral glucocorticoids, and antibiotics.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Short-acting bronchodilators for COPD exacerbations\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[00:35]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>Let's start with the short-acting bronchodilators which include albuterol and ipratropium. When delivering these medications, there is no significant benefit in using either a metered dose inhaler or a nebulizer. I personally prefer inhalers because they are more accessible and convenient, since the patient won't need an additional device or electricity source.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Oral glucocorticoids in acute COPD exacerbation treatment\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[01:01]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>Glucocorticoids, namely prednisone, shorten recovery time, improve lung function, improve oxygenation, and improve treatment success. A dose of 40 mg a day for a maximum of five days is routine. When prescribing steroids, be aware that longer courses of steroids can be associated with increased risk of infection and mortality. Importantly, there's no difference between oral versus intravenous or intramuscular administration of steroids, but you will want to make sure that the patient can safely ingest the oral form before prescribing it. The sooner you start the steroid, the better, as it takes 6 to 12 hours for the steroids to take effect.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Recommendations for antibiotic use in COPD exacerbations\u003C\u002Fspan>\u003C\u002Fh3>\u003Ch4 dir=\"ltr\">\u003Cspan>When to use antibiotics\u003C\u002Fspan>\u003C\u002Fh4>\u003Cp dir=\"ltr\">\u003Cspan>[01:51]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>The use of antibiotics in COPD is controversial. There is evidence supporting the use of antibiotics in patients with signs of bacterial infection, like increased sputum purulence, which can appear as yellow or greenish in color. The problem is that the sputum color is not very reliable, and we likely over prescribe antibiotics which leads to downstream negative issues like resistance and side effects.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch4 dir=\"ltr\">\u003Cspan>CRP-guided antibiotic use\u003C\u002Fspan>\u003C\u002Fh4>\u003Cp dir=\"ltr\">\u003Cspan>[02:22]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>Two randomized studies showed a significant reduction in antibiotic prescription when their use was guided by the C-reactive protein, or CRP, levels in the blood. The downside is that the point-of-care testing for CRP is not often available in the outpatient setting.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch4 dir=\"ltr\">\u003Cspan>GOLD recommendations for antibiotic treatment\u003C\u002Fspan>\u003C\u002Fh4>\u003Cp dir=\"ltr\">\u003Cspan>[02:42]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>So the Global Initiative for Chronic Obstructive Lung Disease, or GOLD, recommends a three to five day course of antibiotics for patients presenting with increased shortness of breath, sputum volume, and purulence. The choice of antibiotics should be based on your local bacterial resistance pattern, but suitable antibiotics include amoxicillin with clavulanic acid, macrolides, doxycycline, or tetracycline.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Mild vs. moderate COPD exacerbations\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[3:11]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>Assuming your patient is stable and is presenting with a mild exacerbation to an outpatient clinic, the mainstay of therapy is short-acting bronchodilators. In the outpatient setting, caring for a patient with moderate exacerbation can be tricky. If you feel that your patient is responding to short-acting bronchodilators and can continue therapy at home, they can be managed as an outpatient with the addition of a short course of oral steroids and possibly antibiotics.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>When acute COPD exacerbations require hospital care\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[3:45]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>On the other hand, if the patient is not responding or is unable to follow and maintain their medication schedule, they will need to be transferred to the emergency department or directly admitted to the hospital. Other indications for hospitalization include new oxygen requirement, new confusion, respiratory failure, presence of a serious comorbidity like heart failure, new cardiac dysrhythmia, or pulmonary embolism, the need for frequent short-acting beta-2 agonists. And if the patient does not have sufficient home and social support, they may need to be hospitalized as well.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Prognosis after severe COPD exacerbations\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[04:26]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>Unfortunately, the long-term prognosis for patients that require hospitalization for a COPD exacerbation is poor, with a five year mortality rate of about 50% and a poorer quality of life. The independent factors that are associated with poor outcome include older age, presence of comorbidities like cancer or cardiovascular disease, low body mass index, and the need for long-term oxygen therapy after discharge.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>Now you know how to manage COPD exacerbations in the outpatient setting. We'll discuss caring for the patient that you sent to the hospital in another Medmastery lesson.\u003C\u002Fspan>\u003C\u002Fp>",{"courses":248,"showAwardsBelow":48},[249,269],{"id":250,"isFreeCmeCourse":251,"title":252,"type":253,"specialization":254,"teachers":256,"cmeCredits":258,"teacherIllustration":259,"backgroundImage":260,"relativeUrl":261,"lastChanged":262,"created":263,"description":264,"relativeURL":261,"meta":265},3174,false,"Mechanical Ventilation Essentials","course",[255],"Pulmonary",[257],"Josh Cosa, MA RRT-ACCS RRT-NPS RCP",3,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55eb9-e042-4b5f-9b7c-f6f434d1f687","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55eba-e0d7-4aa6-a120-b678c02ecb73","\u002Fcourses\u002Fmechanical-ventilation-essentials","1763556384","1580071907","In this course we'll teach you everything you need to know about mechanical ventilation during your first night in the ICU, how to make initial adjustments in a newly intubated patient, how to fine-tune the ventilator settings to manage patients with restrictive or obstructive respiratory disease, and how to get your patient ready for extubation. We'll take you from respiratory rookie to rockstar!",{"duration":266,"quizzes":267,"lessons":268},6349,5,37,{"id":270,"isFreeCmeCourse":251,"title":271,"type":272,"specialization":273,"teachers":274,"cmeCredits":215,"teacherIllustration":259,"backgroundImage":260,"relativeUrl":275,"lastChanged":276,"created":277,"description":278,"relativeURL":275,"meta":279},3351,"Mechanical Ventilation Essentials Workshop","workshop",[255],[257],"\u002Fworkshops\u002Fmechanical-ventilation-essentials-workshop","1776295455","1580071906","Master the management of patients in respiratory distress through the cases in this hands-on workshop. 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Learn to recognize and report it with exercise stress ECG.",{"alt":299,"title":300,"size":301,"location":303},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":302,"height":302},1200,{"bucket":304,"key":305},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":307,"title":308,"relativeURL":309,"image":310,"professionLong":311,"profession":312,"weight":314},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":313},"Internist",4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":319,"updated":320,"published":321},1778115738,1778118425,1778118255,{"id":323,"title":324,"text":325,"image":326,"author":332,"path":334,"readDuration":335,"readDurationFormatted":336,"internal":337},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":327,"title":300,"size":328,"location":330},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":329,"height":329},600,{"bucket":304,"key":331},"\u002F2026-04\u002FC121_magazine image.png",{"id":307,"title":308,"relativeURL":309,"image":310,"professionLong":311,"profession":333,"weight":314},{"name":313},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":338,"updated":339,"published":340},1777403036,1777572381,1777412421,{"id":342,"title":343,"text":344,"image":345,"author":350,"path":353,"readDuration":354,"readDurationFormatted":317,"internal":355},1346,"Oxygen therapy in COPD: when to start & how to monitor","Not every COPD patient with low oxygen saturation needs supplementary oxygen therapy. Learn the indications for oxygen therapy and how to monitor once started.",{"alt":346,"title":300,"size":347,"location":348},"Patient using nasal cannula for supplemental oxygen therapy in COPD care",{"width":329,"height":329},{"bucket":304,"key":349},"\u002F2026-04\u002FC133(3)_ oxygen therapy _magazine image.png",{"id":282,"title":283,"relativeURL":288,"image":284,"professionLong":287,"profession":351,"weight":352},{"name":286},1533,"\u002Fmagazine\u002Foxygen-therapy-in-copd",168,{"created":356,"updated":357,"published":358},1775953309,1776050389,1775957397,{"seo":360,"og":363},{"title":361,"description":362},"Acute COPD Exacerbation Treatment: Outpatient Care | Medmastery","Not every acute COPD exacerbation needs hospital care. See how to manage mild and moderate exacerbations in the outpatient setting—and when to escalate care.",{"title":364,"description":362,"image":365},"Outpatient Treatment of Acute COPD Exacerbations | Medmastery",{"alt":366,"title":300,"size":367,"location":369},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":302,"height":368},630,{"bucket":304,"key":370},"\u002F2026-04\u002FC133-4_OG image.png",{"id":372,"created":373,"updated":374,"published":375},1347,1776705362,1776710540,1776710541]