Level III: treatment in patients requiring special or intensive care unit
| Supplemental oxygen |
| Ventilatory support |
| Bronchodilators |
| 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 |
| Corticosteroids |
| 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 |
| Amoxicillin/clavulanate |
| Respiratory fluoroquinolones (gatifloxacin, levofloxacin, moxifloxacin) |
| If Pseudomonas spp. and/or other Enterobactereaces spp. are suspected, consider combination therapy |
MDI: metered-dose inhaler