Acute exacerbation of chronic obstructive pulmonary disease

Last reviewed: May 2019

Last updated: April 2018

Summary

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.

May represent the first presentation of COPD, usually associated with a history of tobacco exposure.

Treatment includes bronchodilators, systemic corticosteroids, and antibiotics.

Antibiotics may be reserved for exacerbations thought to be due to bacteria. An acute change in the volume and color of sputum produced is suggestive of a bacterial trigger.

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).

Definition

Chronic obstructive pulmonary disease (COPD) is "a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases." [1]

An exacerbation of COPD may be defined as "an acute worsening of respiratory symptoms that results in additional therapy." [1]

History and exam

Key diagnostic factors

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

Full details

Other diagnostic factors

past medical hx COPD
tobacco use
past medical hx 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

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Risk factors

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

Full details

Diagnostic investigations

1st investigations to order

SaO2 on pulse oximetry
chest radiograph
ECG
Arterial blood gas
CBC with platelets
electrolytes, BUN, + creatinine

Full details

Investigations to consider

sputum culture + Gram stain
respiratory virus diagnostics
cardiac troponin
CT scan of chest

Full details

Emerging tests

procalcitonin

Full details

Treatment algorithm

ACUTE

at presentation

ONGOING

after stabilization

Contributors

Authors VIEW ALL 

Carolyn L. Rochester, MD

Associate Professor

Yale University School of Medicine

New Haven

VA Connecticut Healthcare System

West Haven

Disclosures

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 University School of Medicine

New Haven

Veterans Health Administration

Office of Public Health

West Haven

Disclosures

RAM declares that he has no competing interests.

Peer reviewers VIEW ALL 

Sanjay Sethi, MD

Professor of Medicine

Division Chief

Pulmonary/Critical Care/Sleep Medicine

University at Buffalo

State University of New York

Section Chief

Pulmonary/Critical Care/Sleep Medicine

VA Western New York Healthcare System

Buffalo

Disclosures

SS declares that he has no competing interests.

Francis Thien, MD, FRACP, FCCP

Professor

Box Hill Hospital and Monash University

Victoria

Australia

Disclosures

FT declares that he has no competing interests.

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Acute exacerbation of chronic obstructive pulmonary disease

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

Treatment algorithm

at presentation

after stabilization

Contributors

Authors VIEW ALL 

Carolyn L. Rochester, MD

Disclosures

Richard A. Martinello, MD

Disclosures

Peer reviewers VIEW ALL 

Sanjay Sethi, MD

Disclosures

Francis Thien, MD, FRACP, FCCP

Disclosures

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