Priority 12 from the COPD Exacerbation PSP

UNCERTAINTY: When should a COPD exacerbation be treated with steroids alone, antibiotics alone or both? (JLA PSP Priority 12)
Overall ranking 12
JLA question ID 0104/12
Explanatory note Most exacerbations are treated with a combination of anti-inflammatory 'steroids', with or without antibiotics.  This treats all exacerbations as similar yet there is evidence that exacerbations differ.  This question addresses how best to know which combination of treatments are best for which exacerbation.  Doing so would make sure people get the treatments they need, whilst avoiding unnecessary side-effects (and the cost of) treatments not likely to help. 
Evidence

 The question has not been addressed in the evidence base
Health Research Classification System category  Respiratory
Extra information provided by this PSP
Original uncertainty examples

At what stage do you need to take steroids if it is an exacerbation without infection? ~ How to reduce unnecessary antibiotic prescribing. ~ Is antibiotics always the treatment?
Are anti biotics and steroids the only way to cure exacerbations? ~ some patients are unable to tolerate oral steroids eg causes confusion - what to do then - give antibiotics alone? ~ Do you always need antibiotics for an exacerbation? ~ Length of antibiotic and steroid treatment?  
Submitted by Patient, Carer, Relative, Healthcare professional
PSP information
PSP unique ID 0104
PSP name COPD Exacerbation PSP
Total number of uncertainties identified by this PSP. 51 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 1 April 2021