Chronic obstructive pulmonary disease exacerbation resident survival guide: Difference between revisions
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==Management== | ==Management== | ||
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'''COPD Exacerbation''' <BR> ❑ Cough ↑ <BR> ❑ Dyspnea ↑ <BR> ❑ Sputum ↑ | '''COPD Exacerbation''' <BR> ❑ Cough ↑ <BR> ❑ Dyspnea ↑ <BR> ❑ Sputum ↑ | ||
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❑ Marked increase in intensity of symptoms (eg, sudden development of resting dyspnea) <BR> ❑ Severe underlying COPD <BR> ❑ Onset of new physical signs (eg, cyanosis, peripheral edema) <BR> ❑ Failure of an exacerbation to respond to initial medical management <BR> ❑ Presence of serious comorbidities (e.g., heart failure or newly occurring arrhythmias) <BR> ❑ Frequent exacerbations <BR> ❑ Older age <BR> ❑ Insufficient home support | {{Family tree |border=2|boxstyle=background:WhiteSmoke; |)|-|B1|B1= | ||
<div style="text-align: left; width: 40.5em; padding: 1em">'''Indications for Hospital Assessment or Admission''' <BR> ❑ Marked increase in intensity of symptoms (eg, sudden development of resting dyspnea) <BR> ❑ Severe underlying COPD <BR> ❑ Onset of new physical signs (eg, cyanosis, peripheral edema) <BR> ❑ Failure of an exacerbation to respond to initial medical management <BR> ❑ Presence of serious comorbidities (e.g., heart failure or newly occurring arrhythmias) <BR> ❑ Frequent exacerbations <BR> ❑ Older age <BR> ❑ Insufficient home support | |||
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Revision as of 02:42, 11 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
Definition
- An exacerbation of COPD is an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication.[1][2][3]
- The diagnosis of an exacerbation relies exclusively on the clinical presentation of the patient complaining of an acute change of symptoms (baseline dyspnea, cough, and/or sputum production) that is beyond normal day-to-day variation.[4]
Causes
Life Threatening Causes
Include conditions which may result death or permanent disability within 24 hours if left untreated, and some of them may mimic and/or aggravate exacerbations:
Common Causes
- Respiratory tract infections (~½)
- Unknown (~⅓)
- Air pollutants
Differential Diagnosis
Management
COPD Exacerbation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Indications for Hospital Assessment or Admission ❑ Marked increase in intensity of symptoms (eg, sudden development of resting dyspnea) ❑ Severe underlying COPD ❑ Onset of new physical signs (eg, cyanosis, peripheral edema) ❑ Failure of an exacerbation to respond to initial medical management ❑ Presence of serious comorbidities (e.g., heart failure or newly occurring arrhythmias) ❑ Frequent exacerbations ❑ Older age ❑ Insufficient home support | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Do's
- Monitor fluid balance,nutrition and patient condition closely.
- Consider subcutaneous heparin or low molecular weight heparin.
- Treat associated conditions if exist(e.g., heart failure,arrhythmias).
Don'ts
- Spirometry is not recommended during an exacerbation because it can be difficult to perform and measurements are not accurate enough.
References
- ↑ Burge, S.; Wedzicha, JA. (2003). "COPD exacerbations: definitions and classifications". Eur Respir J Suppl. 41: 46s–53s. PMID 12795331. Unknown parameter
|month=ignored (help) - ↑ Celli, BR.; Barnes, PJ. (2007). "Exacerbations of chronic obstructive pulmonary disease". Eur Respir J. 29 (6): 1224–38. doi:10.1183/09031936.00109906. PMID 17540785. Unknown parameter
|month=ignored (help) - ↑ Rodriguez-Roisin, R. (2000). "Toward a consensus definition for COPD exacerbations". Chest. 117 (5 Suppl 2): 398S–401S. PMID 10843984. Unknown parameter
|month=ignored (help) - ↑ Vestbo, J.; Hurd, SS.; Agustí, AG.; Jones, PW.; Vogelmeier, C.; Anzueto, A.; Barnes, PJ.; Fabbri, LM.; Martinez, FJ. (2013). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". Am J Respir Crit Care Med. 187 (4): 347–65. doi:10.1164/rccm.201204-0596PP. PMID 22878278. Unknown parameter
|month=ignored (help)