Rapid Clinical Updates: Inpatient Management of COPD-Handout

Handout

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Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of hospital admissions and readmissions, yet many management practices are not grounded in strong evidence. Despite financial penalties aimed at improving care quality, significant gaps remain between current and optimal COPD management.<br /><br />Systemic corticosteroids are key in reducing airway inflammation during exacerbations; however, current use often involves high doses, intravenous administration, and prolonged courses, which do not improve survival or reduce readmission rates. Evidence supports a five-day course of oral prednisone 40mg daily as equally effective and safer than longer or higher-dose regimens.<br /><br />Inhaled corticosteroids (ICS) offer benefits for specific COPD patients but have been controversial due to mixed results and pneumonia risk. ICS should not be used as monotherapy. Recent guidance endorses tailoring ICS use based on peripheral eosinophil counts, with higher eosinophilia indicating likely benefit, especially in patients with severe disease and frequent exacerbations.<br /><br />Proper inhaler technique is crucial, as suboptimal use limits treatment effectiveness. Factors such as poor vision, low health literacy, and impaired dexterity hinder correct inhaler use. Educational interventions during hospitalization can improve technique and outcomes. Consideration of nebulizers may enhance medication delivery reliability and affordability for some patients.<br /><br />Overall, focusing on high-yield, evidence-based practices—such as short-course oral corticosteroids, eosinophil-guided ICS therapy, and ensuring proper inhaler use—can improve COPD patient care, reduce readmissions, and minimize adverse events. Ongoing patient education and individualized treatment remain essential components of optimal COPD management.

Keywords

Chronic Obstructive Pulmonary Disease

COPD management

systemic corticosteroids

oral prednisone

inhaled corticosteroids

eosinophil-guided therapy

inhaler technique

hospital readmissions

patient education

nebulizer use