By Dr. Rebecca L. Castillo

Respiratory infections—whether viral or bacterial—are the most common trigger of acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD). For Filipino COPD patients, early recognition and prompt treatment can prevent hospitalizations, preserve lung function, and save lives.

This guide summarizes evidence-based, practical steps in treating respiratory infections in people living with COPD.

Why COPD Patients Are Vulnerable

COPD weakens the lungs’ defenses:

• impaired mucociliary clearance
• chronic inflammation
• reduced airflow
• damaged alveoli

This makes it easier for viruses and bacteria to multiply, leading to pneumonia, bronchitis, or severe exacerbations.

Early Warning Signs: When to Suspect Infection

A COPD patient should seek care immediately if they develop:

• increased shortness of breath
• thicker or darker sputum
• fever or chills
• new wheezing or chest tightness
• fatigue more severe than usual
• reduced activity tolerance
• confusion or drowsiness (especially in older adults)

Any sudden worsening of symptoms requires prompt evaluation.

1. First Line: Optimizing Bronchodilator Therapy

During an infection, airways tighten.
Increase bronchodilator frequency (as advised by a physician):

• short-acting beta agonists (SABA): salbutamol
• short-acting anticholinergics (SAMA): ipratropium

Combination nebulizations (SABA + SAMA) are commonly used during acute episodes.

2. When to Use Antibiotics

Antibiotics are not always needed, especially if the infection is viral.
But they should be given when any of the following “Anthonisen criteria” are present:

A. All three major symptoms:

1. increased breathlessness
2. increased sputum volume
3. increased sputum purulence (yellow/green)

B. Two major symptoms, with purulent sputum included

C. Severe exacerbation requiring ventilation

Recommended antibiotics (5–7 days):

1. Amoxicillin–clavulanate
2. Azithromycin or clarithromycin
3. Doxycycline (useful for mild cases or penicillin allergy)
4. Respiratory fluoroquinolones (for severe cases or multiple comorbidities)

Avoid overuse to prevent antimicrobial resistance.

3. Corticosteroids: When They Help

Short courses of oral corticosteroids improve lung function and shorten recovery.

Standard regimen:
Prednisone 40 mg once daily for 5 days
(or its equivalent)

Steroids are especially indicated for:

• wheezing
• moderate to severe exacerbations
• significant airway inflammation

Avoid prolonged use to prevent side effects.

4. Oxygen Therapy—Given Correctly

COPD patients with infections often present with low oxygen.
Target saturation: 88–92%
Higher levels may worsen CO₂ retention.

Oxygen should be titrated carefully, often in a hospital or clinic setting.

5. Treat Underlying Viral Infections

Most COPD exacerbations are viral, caused by:

• rhinovirus
• influenza
• RSV
• SARS-CoV-2 (COVID-19)

Antivirals may be indicated:

• Oseltamivir for influenza
• COVID-19 antivirals depending on severity and risk category

Vaccination greatly reduces severity.

6. Non-Invasive Ventilation (NIV)

For severe infection-related exacerbations with hypercapnia (high CO₂):

• BiPAP improves oxygenation
• Reduces breathing effort
• Prevents intubation

NIV should be initiated early in qualified facilities.

7. Pulmonary Rehabilitation After an Infection

Many patients experience weakness after an exacerbation.
Pulmonary rehab helps restore:

• strength
• breathing efficiency
• endurance
• confidence in daily activities

Rehab reduces the risk of recurrent infections.

8. Preventing Future Infections

Vaccines:

• annual influenza vaccine
• pneumococcal vaccine
• updated COVID-19 vaccination

Lifestyle and environment:

• avoid exposure to smoke and pollutants
• wear masks on high-pollution days
• maintain good hand hygiene
• stay hydrated and well-nourished

Medication adherence:
Daily inhalers reduce flare-ups by keeping the airways open and reducing inflammation.

“Treating infections early prevents hospitalizations—and protects what’s left of a COPD patient’s lung function.”

Summary

Effective treatment of respiratory infections in COPD rests on:

1. Prompt recognition of worsening symptoms
2. Optimized bronchodilators
3. Judicious antibiotic use
4. Short-course steroids when indicated
5. Careful oxygen management
6. Antivirals for influenza or COVID-19
7. Pulmonary rehabilitation after recovery
8. Vaccination and prevention for long-term protection

With quick action and proper care, COPD patients can recover safely from infections—and avoid life-threatening exacerbations.

“Not every infection needs antibiotics, but every COPD exacerbation needs careful attention.”