COPD Exacerbations: A Guide for Nurse Practitioners

A patient with COPD comes in with worsening cough, sputum, and shortness of breath. Is this actually a COPD exacerbation? Can you safely treat them outpatient? And do they need antibiotics?

In this episode, I walk through a practical approach to evaluating and treating COPD exacerbations in primary care, including updates from the 2025–2026 GOLD guidelines.

We’ll talk through how to rule out other causes of worsening respiratory symptoms, assess exacerbation severity, decide when a patient needs a higher level of care, and choose appropriate treatment—including bronchodilators, prednisone, and antibiotics.

TIMESTAMPS:

00:00 COPD exacerbations: 2025–2026 update

01:30 Confirming COPD + the patient's baseline

02:19 COPD exacerbation or something else?

04:26 Assessing severity + when to escalate care

07:20 COPD exacerbation treatment: inhalers + prednisone

08:00 When do you need antibiotics?

10:45 Follow-up + reassessing long-term COPD treatment

For a full transcript, resources mentioned in this episode, and conversation chapters, visit the blog: www.realworldnp.com/blog/copd-exacerbation-new-nurse-practitioner

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