Increasing reliever therapy during exacerbation is very much part of exacerbation management, increasing fluid intake will help with sputum management so both good practice. Guidance is that we should consider treatment after 48 hours of worsening symptoms (2 out of increased coughing, increased SOB; sputum purulence) unless red flags, such as fever, signs of sepsis etc. Using increased reliver therapy and fluid intake would be sensible in the first 48 hours before starting treatment with steroids (and antibiotics if indicated).

The app currently doesn’t integrate with S1, although the development team are in discussion with NHS IT teams to explore opportunities for optimisation.

Throughout the app patients are notified if there is any indication that they might be at higher risk of an exacerbation (overuse of SABA, poor preventer compliance, etc.) and are advised to speak to their healthcare professional promptly for a review. So, this is a great opportunity to encourage patients to use this digital personalised Asthma/COPD management plan, and we have included some text message templates below which you can use to reach out to your cohort of patients.

Yes highly effective, <50% of exacerbations of COPD are infective. CRP can be used to decide if antibiotics required. OK to wait till the next day to decide whether to start antibiotics unless red flags (fever, signs of sepsis). Steroids should be started whilst waiting for results of CRP if >48 hours of worsening symptoms. Don’t forget NICE recommend sputum culture if sputum still purulent after 2-3 days of antibiotics, this is to ensure targeted antibiotic therapy and can also help to rule out infective cause of exacerbation rather than giving repeated courses of antibiotics.

The evidence for Hib vaccine isn’t strong. Some colleagues however still recommend vaccination as their experience, it has made a difference in those who recurrently grow haemophilus