The decision to use antibiotics is controversial, though antibiotics are warranted in severe exacerbations. According to the 2017 GOLD Executive survey, “antibiotics should be given to patients with acute exacerbations who have three cardinal symptoms: increase in dyspnea, sputum volume, and sputum purulence; have two of the cardinal symptoms, if increased purulence of sputum is one of the two symptoms; or require mechanical ventilation”. 2 A patient with acute, severe exacerbation should be given antibiotics, while considering mimics. Empiric antibiotics for a COPD exacerbation include a 5-7 day course of a macrolide (azithromycin), fluoroquinolone (levofloxacin), tetracycline (doxycycline), or amoxicillin with clavulanic acid. 2
Oxygen therapy is frequently provided along with pharmacological interventions to treat underlying hypoxemia in COPD patients. By reducing hypoxia in the alveoli, pulmonary vasoconstriction is reduced. Reducing pulmonary hypertension lowers right heart afterload, and improves right heart systolic function. Oxygen also reduces hypoxemia in the blood, which reduces the risk of developing polycythemia. However, oxygen therapy has only been shown to reduce mortality in those with severe hypoxemia (PaO2 < 55mmHg); otherwise there is no mortality benefit.