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Investigation of exacerbation of COPD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Diagnosis of an exacerbation is usually made clinically. In patients who have their exacerbation managed in primary care:

  • sending sputum samples for culture is not recommended in routine practice
  • pulse oximetry is of value if there are clinical features of a severe exacerbation

In all patients with an exacerbation referred to hospital

  • a chest radiograph should be obtained
  • arterial blood gas tensions should be measured and the inspired oxygen concentration should be recorded
  • an ECG should be recorded (to exclude comorbidities)
  • a full blood count should be performed and urea and electrolyte concentrations should be measured
  • measure theophylline level on admission in people who are taking theophylline therapy
  • if sputum is purulent, a sample should be sent for microscopy and culture
  • blood cultures should be taken if the patient has pyrexia (1)


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