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

• 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.

• 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.

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:

• Pneumonia
• PE
• Pneumothorax
• Pleural effusion
• CHF
• Cardiac arrhythmias

Common Causes

• Respiratory tract infections (~½)
• Unknown (~⅓)
• Air pollutants

Differential Diagnosis

• Asthma
• CHF
• PE
• ACS
• Pneumothorax
• Pneumonia
• Lobar atelectasis

Management

COPD Exacerbation ❑ Cough ↑ ❑ Dyspnea ↑ ❑ Sputum ↑

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

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.