Management of acute exacerbations

A. High-dose, short-acting beta2 agonists delivered by a metered-dose inhaler with a volume spacer or via a nebulizer remain the mainstays of urgent treatment. Nebulized ipratropium bromide may enhance the bronchodilation provided by a short-acting beta2 agonist. Supplemental oxygen should be used to maintain the oxygen saturation at greater than 90 percent.

B. Most patients require therapy with systemic corticosteroids to resolve symptoms and prevent relapse.

C. Hospitalization should be considered if the PEFR remains less than 70% of predicted. Patients with a PEFR less than 50% of predicted who exhibit an increasing pCO2 level and declining mental status are candidates for intubation.

References: See page 195.

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