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Infective exacerbations of COPD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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An exacerbation can be defined as a sustained worsening of the patient's symptoms from his or her usual stable state that is beyond normal day-to-day variations, and is acute in onset.

  • worsening breathlessness is the key symptom of an exacerbation
    • other symptoms include - increased sputum production and change in sputum colour together with increased cough and wheeze (1,2)

A number of factors have been identified as the cause of exacerbation of COPD:

  • the cause may be unidentified in around 30% of exacerbations
  • infections -
    • viruses - rhinoviruses (common cold), RSV, influenza, parainfluenza,
    • bacteria - H influenza, S pneumonia, Staph aureus,
  • common pollutants - nitrogen dioxide, sulphur dioxide, particulates (1)

Exacerbations can be classified as (1)

  • mild - can be controlled with an increase in dosage of regular medications
  • moderate - requires treatment with systemic corticosteroids or antibiotics
  • severe - requires hospitalization or evaluation in the emergency department (may also be associated with acute respiratory failure) (2)
  • factors which favour treatment in hospital
    • not able to cope at home
    • severe breathlessness
    • general condition is poor/ deteriorating
    • level of activity is poor/confined to bed
    • cyanosis is present
    • worsening peripheral oedema
    • impaired level of consciousness
    • patients is already receiving long term oxygen therapy
    • patient is living alone/ not coping
    • acute confusion is present
    • exacerbation has had a rapid rate of onset
    • there is significant comorbidity particularly cardiac disease and insulin-dependent diabetes)
    • SaO2 < 90%
    • changes on chest radiograph
    • arterial pH level < 7.35
    • arterial PaO2 < 7 kPa

For further details, consult the full guideline (1).


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