Acute exacerbation of chronic obstructive pulmonary disease

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 1 Feb 2026

Last updated: 27 Aug 2025

An acute exacerbation of chronic obstructive pulmonary disease (COPD) typically presents with an increased level of dyspnea, worsening of chronic cough, and/or an increase in the volume and/or purulence of the sputum produced.

An exacerbation may represent the first presentation of COPD.

Treatment includes bronchodilators, systemic corticosteroids, oxygen, and antibiotics. Some patients with more severe exacerbations may require ventilatory support.

Antibiotics are reserved for exacerbations thought to be due to bacteria. An increase in sputum purulence, plus an increase in sputum volume, and/or increased dyspnea, indicates a need for antibiotics.

Treatment may be complicated by the development of hyperglycemia (associated with the use of corticosteroids) and/or diarrhea, including Clostridium difficile-associated diarrhea (associated with the use of antibiotics).

Definição

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition. COPD is characterized by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.[1]

An exacerbation of COPD may be defined as an event characterized by increased dyspnea and/or cough and sputum that worsens in <14 days and may be accompanied by tachypnea and/or tachycardia. An acute exacerbation of COPD is often associated with increased local and systemic inflammation caused by infections, pollution, or other insult to the airway.[1]

Typically, COPD exacerbations are characterized by a worsening of airflow obstruction over and above baseline measurements, related to increased airway wall inflammation, mucus production and/or bronchoconstriction. Several conditions including pneumonia, pulmonary embolus, and congestive heart failure can also worsen respiratory symptoms in patients with COPD; these must be differentiated from an acute exacerbation of COPD.

História e exame físico

Principais fatores diagnósticos

dyspnea
cough
wheeze
changes in sputum volume/color/thickness
tachypnea
cyanosis

Detalhes completos

Outros fatores diagnósticos

past medical history of COPD
tobacco dependence
past medical history of gastroesophageal reflux/swallowing dysfunction
malaise and fatigue
chest tightness
features of cor pulmonale
environmental/occupational exposure to pollutants or dust
change in mental status
fever
accessory muscle use
paradoxical movements of abdomen

Detalhes completos

Fatores de risco

viral infection
bacterial infection
gastroesophageal reflux/swallowing dysfunction
smoking
atypical bacterial infection
air pollutants
change in weather

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

oxygen saturation on pulse oximetry
chest x-ray
ECG
ABG
CBC with differential
eosinophil count
CRP
basic metabolic panel for electrolytes, BUN, + creatinine

Detalhes completos

Investigações a serem consideradas

sputum culture + Gram stain
respiratory virus diagnostics
cardiac troponin
B-type natriuretic peptide (BNP)
CT scan of chest

Detalhes completos

Novos exames

procalcitonin
vitamin D
immunoglobulins

Detalhes completos

Algoritmo de tratamento

AGUDA

at presentation

CONTÍNUA

after stabilization

Colaboradores

Consultores especialistas

Carolyn L. Rochester, MD

Professor of Medicine

Yale School of Medicine

New Haven

VA Connecticut Healthcare System

West Haven

Divulgaciones

CLR serves on the COPD scientific advisory board for GlaxoSmithKline Pharmaceuticals but has no competing interests pertaining to this publication.

Richard A. Martinello, MD

Associate Professor

Yale School of Medicine

New Haven

Divulgaciones

RAM declares that he has no competing interests.

Revisores por pares

Antonio Anzueto, MD

Professor of Medicine

University of Texas Health

Section Chief

South Texas Veterans Health Care System

San Antonio

Divulgaciones

AA has been a consultant for GlaxoSmithKline, AstraZeneca, Boehringer-Ingelheim, Theravance and Grifols. AA has been reimbursed for his services by these companies. AA is a member of the GOLD scientific committee.

Agradecimiento de los revisores por pares

Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.

Divulgaciones

Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.

Consejeros especializados: comorbilidades

Pankaj Shah, MD

Endocrinologist

Assistant Professor of Medicine

Department of Internal Medicine

Chair, Hospital Diabetes and Endocrinology Core Group

Mayo Clinic

Rochester

Divulgaciones

As part of his job at his institute, PS provides expert opinion in a physician education tool called "Ask Mayo Expert", where he is one of several "Subject Matter Experts." He also addresses academic educational activities in the US and abroad as part of his institutional duty. PS declares no other competing interests.

Preethi Pirlamarla, MD

Physician (Cardiologist)

Advanced Heart Failure and Cardiac Transplant

Director of Quality Improvement for Advanced Heart Failure Department

Heart Institute at University of Washington Medical Center - Montlake

Seattle

Divulgaciones

PP declares that she has no competing interests.

Lorenzo Azzalini, MD, PhD, MSc, FACC, FSCAI

Associate Professor of Medicine

Division of Cardiology

Department of Medicine

University of Washington

Director of Interventional Cardiology Research, Heart Institute at University of Washington Medical Center - Montlake

Seattle

Divulgaciones

LA has received consulting fees from Teleflex, Abiomed, GE Healthcare, Reflow Medical, Shockwave, Abbott, and Cardiovascular Systems, Inc.; received a research grant by Abiomed; serves on the advisory board of Abiomed and GE Healthcare; and owns equity in Reflow Medical.

Philip R. Muskin, MD, MA, DLFAPA, LFACLP

Professor of Psychiatry

Columbia University Irving Medical Center

Senior Consultant in Consultation-Liaison Psychiatry

New York-Presbyterian/Columbia University Irving Medical Center

New York

Divulgaciones

PRM is an Associate Editor of American Psychiatric Association Publishing and on the editorial board for the journal Focus, for which he receives no compensation. At the American Board of Psychiatry and Neurology he is a member of the Article Based Certification Committee for Consultation-Liaison Psychiatry (no compensation), and at the American Psychiatric Association he is a member of the Scientific Program Committee for the Annual Meeting 2025 (no compensation) and will be on this committee in 2026. PRM serves as an expert witness in psychiatric malpractice lawsuits, for which he is compensated. He was grant co-investigator for the proposal “Can hypnosis enhance the ability to regulate behavioral and brain markers of emotion regulation?” (Proposal No. 75037-NS, Department of the Army, US Army Combat Capabilities Development Command, Army Research Office), which ended in 2023. PRM receives royalties from American Psychiatric Association Publishing for The American Psychiatric Publishing Study Guide for the Psychiatry Board Examination (edited by Muskin PR and Dickerman AL, American Psychiatric Publishing, 2016), and makes presentations at the American Psychiatric Association and Academy of Consultation-Liaison Psychiatry Annual Meetings.

Seki Balogun, MD, FACP, AGSF

Professor of Medicine

Geriatrician and Palliative Care Physician

University of Oklahoma Health Sciences Center

Oklahoma City

გაფრთხილება:

SB serves on the United States Medical Licensing Examination (USMLE) Step 3 Interdisciplinary Review Committee.

Khalilah Gates, MD

Associate Professor of Medicine (Pulmonary and Critical Care)

Assistant Dean of Learning and Academic Performance

Division of Pulmonary and Critical Care

Department of Medicine

Northwestern University Feinberg School of Medicine

Medical Director, Diversity and Inclusion Education

NM Academy

Chicago

გაფრთხილება:

KG is a Board Member of the Respiratory Health Association, where she focuses on communication for COPD and asthma and has no financial agreements or obligations.

Karen Jubanyik, MD

Associate Professor of Emergency Medicine

Director

Emergency Medicine Clerkship

Yale School of Medicine

New Haven

Divulgaciones

KJ declares that she has no competing interests.

Ziad Zoghby, MD, MBA, FACP

Associate Professor of Medicine

Division of Nephrology and Hypertension

Department of Medicine

Mayo Clinic

Rochester

Divulgaciones

ZZ received fees for consultancy work in 2022 and 2023 for ChroniSense Ltd, a remote digital health company. He has served since 2018 on the Nephrology Specialty Board for EPIC, an electronic health record vendor, and is the elected Chair of the Board for 2024-2025 (a nonpaid position).

Madeleine Alexeeva, DO

Emergency Medicine Physician

Vituity

Visalia

Associate Program Director of Emergency Medicine Residency

Kaweah Health Medical Center

Visalia

Divulgaciones

MA declares that she has no competing interests.

Lindsey Phillips, MD

Assistant Professor of Medicine

University of North Carolina School of Medicine

Chapel Hill

Divulgaciones

LP declares that she has no competing interests.

Michael S. Phipps, MD, MHS

Associate Professor of Neurology and Epidemiology and Public Health

University of Maryland School of Medicine

Director of the Brain Attack Center at the University of Maryland Medical Center

Baltimore

Divulgaciones

MSP declares that he is a member of the American Academy of Neurology Quality Committee (non-financial), a Liaison, American Heart Association, QCOR Committee (non-financial) and a member of the International Stroke Conference Program Committee (non-financial). No financial disclosures.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for prevention, diagnosis and management of COPD: 2025 report. 2025 [internet publication].Texto completo

Stevermer JJ, Fisher L, Lin KW, et al. Pharmacologic management of COPD exacerbations: a clinical practice guideline from the AAFP. Am Fam Physician. 2021 Jul 1;104(1):Online.Texto completo Resumen

Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct 15;188(8):e13-64. Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible aquí.

El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad

Acute exacerbation of chronic obstructive pulmonary disease

Summary

Definição

História e exame físico

Investigações diagnósticas

Algoritmo de tratamento

Colaboradores

Consultores especialistas

Carolyn L. Rochester, MD

Divulgaciones

Richard A. Martinello, MD

Divulgaciones

Revisores por pares

Antonio Anzueto, MD

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Consejeros especializados: comorbilidades

Pankaj Shah, MD

Divulgaciones

Preethi Pirlamarla, MD

Divulgaciones

Lorenzo Azzalini, MD, PhD, MSc, FACC, FSCAI

Divulgaciones

Philip R. Muskin, MD, MA, DLFAPA, LFACLP

Divulgaciones

Seki Balogun, MD, FACP, AGSF

გაფრთხილება:

Khalilah Gates, MD

გაფრთხილება:

Karen Jubanyik, MD

Divulgaciones

Ziad Zoghby, MD, MBA, FACP

Divulgaciones

Madeleine Alexeeva, DO

Divulgaciones

Lindsey Phillips, MD

Divulgaciones

Michael S. Phipps, MD, MHS

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible aquí.

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