Therapeutic Handbook - GGC Prescribing

Treatment options continued• If persistent acidotic hypercapnic ventilatory failure despite optimal medical therapy considerdiscussion with ITU and/or non-invasive ventilation (NIV) - see protocol on next page)• Mucolytic therapy may be of symptomatic benefit in patients where sputum clearance istroublesome:Carbocisteine oral 750 mg three times daily then reduced to 1.5 g daily in divideddoses as condition improves.• Nicotine replacement therapy if appropriate (see Appendix 1).• Consider for referral to early supported discharge team (British Lung Foundation Nurses).Respiratory SystemPrior to discharge1. Check inhaler technique and drug regimen: stop nebulised bronchodilator for 24 hours prior todischarge (if not used at home and not discharged under early supported discharge protocol).Home nebulisers should not be introduced as routine treatment immediately after acuteexacerbation.2. Prednisolone oral 30 mg - 50 mg each morning for 7 days, without dose tapering, will besuitable for most patients.N.B. There may be circumstances however where a tapering dose is necessary, e.g. inpatients who are oral steroid dependent. In such circumstances reduce the dose to the normalmaintenance dose or 10 mg daily (whichever is the greater) with a plan for early outpatient reviewor refer to local unit protocol.Clinical improvement with oral steroids in acute COPD does not indicate need for long-terminhaled steroid.3. Physiotherapy advice regarding pulmonary rehabilitation.4. Smoking cessation advice and referral if appropriate (see Appendix 1).5. Home oxygen is usually assessed as an outpatient when patients are stable for at least 6 weekspost exacerbation and an ex-smoker or non-smoker.6. Ensure optimal inhaled medication prior to discharge (see page 137).Page 140