Level I: outpatient treatment
| Patient education |
| Check inhalation technique |
| Consider use of spacer devices |
| Bronchodilators |
| Short-acting β2‐agonist# and/or ipratropium MDI with spacer or hand-held nebuliser as needed |
| Consider adding long-acting bronchodilator if patient is not using one |
| Corticosteroids (the actual dose may vary) |
| Prednisone 30–40 mg orally·day−1 for 10–14 days |
| Consider using an inhaled corticosteroid |
| Antibiotics |
| May be initiated in patients with altered sputum characteristics+ |
| Choice should be based on local bacterial resistance patterns |
| Amoxicillin/ampicillin¶, cephalosporins |
| Doxycycline |
| Macrolides§ |
| If the patient has failed prior antibiotic therapy consider: |
| Amoxicillin/clavulanate |
| Respiratory fluoroquinolonesƒ |
MDI: metered-dose inhaler
#: salbutamol (albuterol), terbutaline
+: purulence and/or volume
¶: depending on local prevalence of bacterial β‐lactamases
§: azithromycin, clarithromycin, dirithromycin, roxithromycin
ƒ: gatifloxacin, levofloxacin, moxifloxacin