What are the current recommendations for prehospital management of patients with exacerbations of chronic obstructive pulmonary disease (COPD) by emergency medical services?
Jadwiga Wedzicha: Exacerbations of COPD are very serious events. The most important thing for me is early recognition of symptoms. It is very important that the patient lets the emergency services know as soon as possible that there is a problem, especially if he or she is on oxygen therapy or likely to go into respiratory failure.
Once the emergency services arrive, they will assess the severity of the condition, whether the patient needs hospitalization, and it may be that they can be treated as an outpatient. If there is any evidence of hypoxia of respiratory failure, they will give oxygen, but they have to give low-dose controlled oxygen to minimize the risk of hypercapnia. The emergency services may treat with steroids, antibiotics, and make a decision then about transfer to hospital. If the patient is verging on respiratory failure, cannot cope, has a bad infection, pneumonia, then they will need admission to hospital.