Patient handout

COPD (chronic GOLD ABE + exacerbation)

PRODUCTION

1. Your condition

This handout is for copd (chronic gold abe + exacerbation). Your care team identified this based on: chronic dyspnea, productive cough, chest tightness in smoker/ex-smoker (gold 2026 diagnosis).

Other reasons your team may use this plan: acute exacerbation: increased dyspnea + sputum volume + purulence (anthonisen 1987); post-bronchodilator fev1/fvc <0.70 (gold 2026 diagnostic criterion); existing copd — annual review or post-exacerbation visit (gold 2026 follow-up & prevention).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
tiotropium OR salbutamol PRN	Tiotropium 18 µg HandiHaler OR 2.5 µg Respimat 2 puffs daily; albuterol 100 µg 2 puffs PRN	inhaled	once daily LAMA OR PRN SABA	GOLD 2026 Group A — long-acting bronchodilator preferred (UPLIFT, Tashkin NEJM 2008); PRN SABA acceptable for occasional symptoms

Plan: GOLD 2026 ABE stepwise — chronic outpatient

3. When to call your provider

Contact your care team if any of the following happen:

Acute exacerbation with severe symptoms or O2 requirement → ED (GOLD 2026 Exacerbations)
Failure to thrive / unintended weight loss → MDT review (GOLD 2026 Pharmacotherapy)
Worsening cor pulmonale / right HF → cardiology + pulmonary HTN evaluation (GOLD 2026 Multimorbidity)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

pH 7.25–7.35 + PaCO2 >45 + RR >25 + dyspnoea (Plant 2000 NIV criteria)
pH <7.25 OR no improvement in pH after 1–2 h of NIV (Plant 2000)(life-threatening)
AMS in COPD exacerbation — CO2 narcosis OR hypoxic encephalopathy (GOLD 2026 Exacerbations)(life-threatening)
Acute decompensation in known COPD — is it AECOPD or a mimic? §5.5.2 exacerbation differential: infective (Anthonisen ≥2 + purulence) vs PE (disproportionate hypoxia, no sputum change → D-dimer/CTPA) vs decompensated HF (orthopnea/JVD/natural marker of fluid overload (NT-proBNP)↑↑/echo) vs CAP (lobar consolidation CXR, CURB-65) vs pneumothorax (sudden pleuritic + ↓breath sounds, CXR/POCUS — bullous COPD high SSP risk) (GOLD 2026 Exacerbations)

5. Follow-up

Vaccinations (flu, pneumococcal PCV20 or PCV15+PPSV23, RSV, COVID, Tdap), smoking cessation reinforcement, pulmonary rehab within 3 weeks of discharge (Puhan 2016), advance care planning, follow-up clinic visit in 7 days post-exacerbation (Seemungal 2000)

6. Sources

Guideline: GOLD 2026 Report (v1.3, 2025-12-08) + ATS/ERS 2023 COPD Exacerbation Management