Clinical Medical-Surgical Practice Exam

During a COPD exacerbation in the emergency department, the immediate goal is to rapidly relieve bronchospasm and reduce airway inflammation while ensuring adequate oxygenation. The best initial pharmacologic approach combines inhaled short-acting bronchodilators with systemic corticosteroids. Short-acting bronchodilators, such as a beta-agonist inhaler (often given with an anticholinergic agent), provide quick relief of airway constriction. Systemic corticosteroids help decrease airway inflammation, speed up recovery, and improve lung function and symptoms.

Antibiotics are added if there are signs that the exacerbation is driven by a bacterial infection—such as increased sputum purulence, volume, and dyspnea—or in patients at high risk for a bacterial trigger or needing ventilation. They are not given to every patient with an exacerbation. Oxygen should be administered to maintain SpO2 in the target range (usually about 88–92% for COPD patients) to avoid hypoxemia while preventing CO2 retention.

Long-acting bronchodilators are maintenance therapies and do not provide the rapid relief needed in an acute ED visit, so they are not considered first-line for the immediate treatment of an acute exacerbation. Antibiotics alone do not address the acute bronchospasm and inflammation, and oxygen alone does not treat the inflammatory and bronchial components of the flare.