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).
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.
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.
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.
History and exam
- past medical history of COPD
- tobacco use
- 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
- accessory muscle use
- paradoxical movements of abdomen
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