Table 12

Level III: treatment in patients requiring special or intensive care unit

Supplemental oxygen
Ventilatory support
 Short-acting β2‐agonist (salbutamol (albuterol)) and ipratropium MDI with spacer, two puffs every 2–4 h
 If the patient is on the ventilator, consider MDI administration
 Consider long-acting β‐agonist
 If patient tolerates oral medications, prednisone 30–40 mg orally·day−1 for 10–14 days
 If patient cannot tolerate, give the equivalent dose i.v. for up to 14 days
 Consider using inhaled corticosteroids by MDI or hand-held nebuliser
Antibiotics (based on local bacteria resistance patterns)
 Choice should be based on local bacteria resistance patterns
 Respiratory fluoroquinolones (gatifloxacin, levofloxacin, moxifloxacin)
 If Pseudomonas spp. and/or other Enterobactereaces spp. are suspected, consider combination therapy
  • MDI: metered-dose inhaler