COPD exacerbation

• Salbutamol + Ipratropium, Prednisolone, Oxygen (venturi 24–28%)
• Purulent sputum — one of: Amoxicillin-clavulanate, Doxycycline, Azithromycin, Ceftriaxone (admitted)
• On discharge: LAMA + LABA (e.g. tiotropium + formoterol)

First visit

• SpO₂ — Target 88–92%; under 88% on air needs oxygen and assessment.
• Chest X-ray — Exclude pneumonia, pneumothorax and heart failure.

Only if indicated

• Arterial blood gas — SpO₂ under 88%, drowsiness or on oxygen — hypercapnia decides NIV.
• Sputum culture — Purulent sputum not responding to the first antibiotic, or frequent exacerbations.
• ECG, CBC, creatinine — Admitted, or palpitations or heart disease.
• Sputum NAAT for TB — Cough over 2 weeks with weight loss or fever.

Follow-up and monitoring

• Spirometry — When stable, to confirm COPD (post-bronchodilator FEV₁/FVC under 0.7).
• Blood eosinophil count — Guides inhaled steroid use (300/µL or more favours ICS).