Criteria for stand-by medication

• Any patient with a confirmed diagnosis of COPD, interstitial lung disease (ILD) or bronchiectasis who has had two or more exacerbations (infections) in a 12-month period
• Any patient who has visited A&E or been admitted to hospital with an exacerbation of COPD, ILD or bronchiectasis
• Patients who recognise when an exacerbation is starting and have been assessed with a self-management plan in place to reduce the risk of exacerbations.

Antibiotics: the facts

Antibiotics are used to treat or prevent some types of bacterial infection. They work by killing bacteria or preventing them from reproducing and spreading. However, they do not work for everything.

When it comes to antibiotics, take your doctor’s or clinician’s advice.

Antibiotics do not work for viral infections such as coughs, sore throats, colds and flu.

Many mild bacterial infections also get better on their own without using antibiotics.

Taking antibiotics when you do not need them puts you and your family at risk of a longer and more severe illness.

In the presence of a true penicillin allergy

Do not take the following medications:

• amoxicillin
• flucloxacillin
• co-amoxiclav.

Only half of COPD exacerbations (infections) respond to antibiotics.

Do not share your prescription with anyone else and return unused antibiotics to the pharmacy.

Complete the full course prescribed even if you are feeling better.

Do not flush unused antibiotics down the toilet.

If you experience any adverse side effects

Please promptly inform the prescriber or your GP. If a severe reaction occurs, call 999.

Steroids: the facts

Steroid tablets, also called corticosteroid tablets, are a type of anti-inflammatory medicine used to treat a range of conditions. For respiratory conditions, Prednisolone is used.

The dose is calculated according to weight, either 30mg (six tablets) or 40mg (eight tablets), to be taken with or after food in one dose. Ideally, it should be taken early in the morning as it can cause sleep disturbance.

Side effects can be:

• indigestion or heartburn
• increased appetite, which could lead to weight gain
• difficulty sleeping
• changes in mood and behaviour, such as feeling irritable or anxious
• an increased risk of infections, especially chickenpox, shingles and measles
• high blood sugar or diabetes
• weakening of the bones (osteoporosis)
• high blood pressure
• Cushing's syndrome, with symptoms such as thin skin that bruises easily, stretch marks on the thighs and fat deposits in the face
• eye conditions, such as glaucoma and cataracts
• mental health problems, such as depression or suicidal thoughts.

Most side effects will pass once treatment stops.

What is an exacerbation?

An exacerbation is a sustained worsening of the person's symptoms from their usual stable state which is beyond normal day-to-day variations and is acute in onset.

Commonly reported symptoms are:

• worsening breathlessness
• tight chest
• cough
• increased sputum production
• change in sputum volume and colour (green/yellow and thicker).

Types of exacerbation (flare-up)

Mild exacerbation

The person has an increased need for medication, which they can manage in their normal environment.

Moderate exacerbation

The person has a sustained worsening of respiratory symptoms that requires treatment with systemic corticosteroids (Prednisolone) and/or antibiotics.

Severe exacerbation

The person experiences a rapid deterioration in respiratory status that requires hospitalisation.

My normal symptoms

My normal sputum colour is: ..................................................

My normal sputum amount each day is: .......... teaspoons/tablespoons

I cough up sputum every day: Yes / No

My triggers are: ..................................................................

When you are feeling more breathless than usual

Ask yourself the following questions:

• have you taken your inhalers today?
• have you increased your reliever inhaler?
• salbutamol can be used up to two puffs, four times a day, and works for four to six hours when used with a spacer, if available
• a handheld battery-operated fan on the side of the face may help
• are you taking any other medication prescribed to help your breathing?

If your symptoms improve

Your flare-up may have been caused by triggers such as:

• smoking
• anxiety
• dust
• weather changes
• perfumes
• a viral infection
• heating
• air conditioning.

Continue the measures above for the next few days and monitor your symptoms.

If your symptoms do not improve

Ask yourself the following questions:

• has your sputum become thicker, but remained clear, white or your normal colour, with an increased cough?
• are you drinking two litres of fluid in 24 hours?
• are you carrying out your chest clearance technique, such as the Active Cycle of Breathing Technique (ACBT), or using your Acapella, Flutter or Aerobika device as advised in your plan?
• are you taking the correct dose of Carbocisteine to thin your sputum, if prescribed? ....................................

If your symptoms improve

Continue the measures above as part of your daily routine to ensure you remain hydrated and your airways stay clear of sputum.

If your symptoms do not improve

• check that you are taking your inhalers correctly
• visit RightBreathe for inhaler technique support
• contact the respiratory team or your GP for advice
• out of hours, call NHS 111
• you need an assessment by a healthcare professional
• please consider providing a sputum sample if advised by your clinician.