In an acute COPD exacerbation with respiratory acidosis, which therapy is included in initial management?

• A. Inhaled bronchodilators, systemic corticosteroids, and antibiotics if infection
• B. Oxygen therapy only
• C. Mechanical ventilation immediately
• D. Antibiotics only

Answer: (A)

When a COPD flare causes respiratory acidosis, the priority is to rapidly open the airways, reduce airway inflammation, and address any infectious trigger. Inhaled bronchodilators relieve bronchospasm and improve ventilation right away. Systemic corticosteroids decrease airway inflammation, shorten the duration of the exacerbation, and improve lung function. If there is suspicion of bacterial infection—often suggested by increased sputum production and purulence—antibiotics are added to treat that trigger. Oxygen is used to correct hypoxemia, but it’s not sufficient on its own and should be given alongside bronchodilators and steroids. Mechanical ventilation is reserved for patients who fail initial therapy or develop life-threatening respiratory failure.