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Emergency Department Discharge Instructions

COPD - chronic obstructive pulmonary disease

Emergency Care Discharge Instructions

Instruction summary

COPD stands for Chronic Obstructive Pulmonary Disease. This is a chronic (long-term) disease caused by permanent damage to the lungs, most often due to cigarette smoke. A COPD exacerbation or flare is a worsening of the shortness of breath, along with increased sputum production (the phlegm that you cough up) or an increase in the purulence of the sputum (i.e. it is thicker and greener than usual).

Unfortunately, the treatment for COPD doesn’t work immediately. Instead it works gradually, over time.

If you were prescribed antibiotics and prednisone (a steroid), take the full course of both. Prednisone is very helpful for your lungs. If you take it for many months, it can have lots of long-term side effects, but in the short-term, it will likely just make you feel moody and have an increased appetite. Some patients have difficulty sleeping when taking prednisone. If this happens to you, take the prednisone first thing in the morning, rather than later in the day.

If you have COPD, you have probably been taking long-acting puffers, like Spiriva or Advair. Keep using these puffers, but in a COPD exacerbation you will need to add a short-acting puffer as well, like Ventolin (the blue puffer) or Atrovent. Take two puffs of the short-acting puffer every four hours while you are awake for the next couple of days, then as needed.

If you haven’t used the Atrovent in three days or the Ventolin in 14 days, you need to prime it before you use it again. To prime it, take off the cap and point the puffer away from you. Next, press the button on the puffer four times.

To use the puffer, breathe out, put your lips on the puffer and then breathe in gradually and fully as you press the button on the puffer.

Drink lots of water, avoid second hand smoke, and remember to get your flu vaccination.

Reasons to return to the ER
  1. If you cannot speak a full sentence when sitting down
  2. If your shortness of breath is worse than when you left the ER
  3. If you have a new fever, or have developed a fever (≥38.0 °C or 100.4 °F) after two days of taking the antibiotics
  4. If you have increased confusion