A 58-year-old man with COPD presents with two days of worsening dyspnea and increased sputum. After albuterol-ipratropium nebulizer treatment, his oxygen saturation improves to 94% and work of breathing decreases. Which is the most appropriate next step?

• A. Admit to hospital for monitoring
• B. Discharge to home with prednisone and azithromycin for five days
• C. Start IV antibiotics and observe
• D. Begin systemic steroids and bronchodilators with inpatient observation

Answer: (B)

Stabilized COPD exacerbations can be managed safely at home when the patient is breathing comfortably, has adequate oxygenation, and can take oral meds. In this case, after initial bronchodilator therapy the patient’s oxygen saturation is 94% on room air and work of breathing has decreased, so admission isn’t needed. A short course of systemic steroids accelerates recovery from a COPD flare, and antibiotics are appropriate when the patient has increased sputum with worsening symptoms, as seen here. Using prednisone for about five days helps reduce inflammation and shorten the illness, while azithromycin targets common bacterial contributors in COPD exacerbations. Because the patient is now stable, discharge with these medications is preferable to inpatient monitoring or IV therapy.