Chronic obstructive pulmonary disease exacerbation resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
Definition
COPD exacerbation commonly caused by infections, should be recognized when any of the following symptoms is noticed in a chronic COPD patient:[1]worsening cough, increasing dyspnea, increasing in sputum production more than the baseline for chronic COPD patients.[1]
Causes
Life Threatening Causes
Include conditions which may result death or permanent disability within 24 hours if left untreated. Some conditions that may mimic and/or aggravate exacerbations:
Common Causes
- Respiratory tract infections 50%(bacterial or viral).
- Exposure to pollutants.
- Unknown (⅓ of cases ).
Differential Diagnosis
Management
| COPD Exacerbation ↑cough, ↑dyspnea, ↑sputum, ↑wheezing, fever or chest tightness | |||||||||||||||||||||
| Admission | |||||||||||||||||||||
| Assessment : 1-O2 sat+ ABG 2-CXR 3-EKG 4-CBC
1-Inhaled bronchodilators 2-Systemic corticosteroids 3-Empirical antibiotics 4-O2 (target Sat >90%) | Corticosteroids(Solumedrol) Methylprednisolone 125 mg×1 dose followed with 60-80 mg Q8-12based on severity IV Solumedrol to PO Prednisone taper 4--60 mg Q 8-12 2-5 days taper depending on severity Antibiotics Group A* Doxycycline Cap Vibramycin PO 100 mg Q12H (if unable to tolerate choose Cefpodoxime Tab Vantin PO 200 mg Q12H) Group B* Ceftriaxone Inj Rocephin 1GM D5W50 ml Q24H 200 ml/Hr (If Beta-Lactam allergy choose Levofloxacin Tab Levaquin PO 500 mg daily ) Group C*** Ciprofloxacin Tab CiproPO 250 Daily or Ciprofloxacin Inj Cipro 400 mg premixed at 400 mg /200 ml Q12H 200 ml/Hr. | ||||||||||||||||||||
| Respiratory acidosis? OR PH≤35? OR PaCo2≥45? OR Severe signs of dyspnea? OR (Accessory muscles use, paradoxical motion of abdomen, retraction of intercostal space | |||||||||||||||||||||
| No | Yes | ||||||||||||||||||||
| Continue the same management | ICU Admission NIV | ||||||||||||||||||||
| Unable to tolerate NIV? Severe hemodynamic instability? Resp/cardiac arrest ? | |||||||||||||||||||||
| Invasive mechanical ventilation | |||||||||||||||||||||
*Group A:mild exacerbation, no risk factors, 2>symptoms present
Group B:Mod Exacerbation w/risk factors for poor outcomes:comorbid disease, severe COPD, Frequent exacerbation>3, Antimicrobial use within the last 3 months
Group C:Severe exacerbation w/risk factors for P.aeruginosa infection.
References
- ↑ 1.0 1.1 Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P; et al. (2007). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". Am J Respir Crit Care Med. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545.