CRP and Antibiotic use in Acute COPD Exacerbations

By Dr. Nihal Varkey

Edited by Kevin Cao 

Clinical Question: 

Does CRP Help Reduce Antibiotic Prescriptions in Acute COPD Exacerbations?


As we all know, many of the exacerbations we see in the ED are precipitated by either infection, cold weather, pulmonary embolus, pneumothorax, CHF or trauma. We have an algorithm for treating exacerbations that uses a combination of the GOLD criteria, which stratifies exacerbations based on severity, and the Anthonisen criteria which is a subjective means of using our clinical gestalt to see who needs antibiotics. 

With there being a strong push for limiting the use of antibiotics and preventing resistance, I wanted to take a look at this study which questions whether testing C-Reactive Protein (CRP) changes our management and limits our antibiotic use for COPD exacerbations.

Study Design

The authors of this trial wanted to test point of care CRP in patients with acute COPD exacerbations.  They hypothesized that the results of Point-of-care (POC) CRP may help inform prescribing decisions for acute COPD exacerbations.  It was a multicenter, open-label, randomized controlled trial where patients were recruited from 86 general medical practices in the UK.


Conclusion (K-Bomb):

What’s the bomb?


What were the strengths?


What were the limitations? 


Butler CC, Gillespie D, White P, et al. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations. N Engl J Med 2019;381:111-120.

Key Terms: Chronic Obstructive Pulmonary Disease (COPD), C-Reactive Protein (CRP), Point of Care (POC), Antibiotics (ABX),