COPD rescue pack instructions
When to start the emergency antibiotics and steroids, when not to, and what to do straight afterwards.
Your rescue pack You have been given a supply of antibiotics and steroid tablets to keep at home, so that you can start treatment quickly if you have a flare-up. This only works safely if it is used for the right thing at the right time, so please read this carefully and keep it with the tablets. How to tell you are having a flare-up For at least two days, and clearly worse than your usual day-to-day symptoms: - you are more short of breath than normal, or - you are coughing up more phlegm than normal, or - your phlegm has changed colour, usually to yellow, green or brown. Feeling a little more breathless on one bad day is not a flare-up. Neither is a runny nose or a sore throat on its own. What to take If you are more breathless than usual, start the steroid tablets: prednisolone [] mg once a day in the morning, for [] days. If your phlegm has increased or changed colour, start the antibiotic: [] [] mg [] times a day, for [] days. If both are true, start both. Finish the full course of each. Do not stop early because you feel better. What to do next Tell your GP practice within one or two days of starting the pack, even if you are improving. This is so your treatment can be reviewed, so the flare-up is recorded, and so your pack can be replaced. A rescue pack is meant to be used once and replaced, not kept and reused. Get urgent help, or call 999, if: - you are severely breathless, or it is getting worse rather than better - you cannot speak in full sentences - you have chest pain - you are coughing up blood - you become drowsy, confused or unusually sleepy - your lips or fingers look blue - you have started the pack and are no better after 48 hours. Important safety points Steroid tablets can raise your blood sugar. If you have diabetes, test more often while you are taking them and follow the advice you have been given about what to do if the readings are high. Steroid tablets can cause indigestion, disturbed sleep and mood changes. Taking them in the morning helps with sleep. Repeated courses of steroids carry risks to bones, eyes and blood sugar, which is another reason to tell us every time you use the pack. If you use the pack more than twice in a year, please ask for a review. Frequent flare-ups usually mean your treatment needs changing, not that you need more rescue packs.
How to use it
The rescue pack is one of the few things a respiratory clinic hands over that can be used wrongly for years without anyone finding out, so the block is written around the two failure modes: starting it for a head cold, and never telling anyone it was used. The two-symptom threshold, the separate triggers for the steroid and the antibiotic, and the instruction to report use within 48 hours are all there for that reason. Blank fields for drug, dose and duration are deliberate — local antimicrobial policy decides the antibiotic, not this block.
Why it says that
None of this is in the copied text. It is here so you can check the block against its source, and change it when the source changes.
- NICE NG115 - Chronic obstructive pulmonary disease in over 16s Offer a short course of an oral corticosteroid and an antibiotic to keep at home, only to people who have had an exacerbation in the last year, remain at risk, understand when to use it, know to tell their clinician, and know to ask for a replacement.
- NICE NG114 - Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing Antibiotic only when sputum has become more purulent or there are clinical signs of pneumonia, and choice according to local resistance data.
- GOLD report - Global Strategy for Prevention, Diagnosis and Management of COPD Short courses of oral steroid of about five days; longer or repeated courses add harm without adding benefit.
Trials behind it
- Anthonisen 1987 1987 Antibiotics helped exacerbations defined by increased dyspnoea, sputum volume and purulence
Records on respiratorytrials.org.