Patients often under-report symptoms of acute exacerbation. Patients should be asked regularly at clinic visits about escalation of symptoms, and educated about the difference between the expected day-to-day variation in symptoms, symptoms of “dyspnea crisis” (related to dynamic hyperinflation), and symptoms heralding a COPD exacerbation. “Dyspnea crisis” is defined as a sustained and severe resting breathing discomfort that occurs in patients with advanced, often life-limiting illness and overwhelms the patient and caregivers’ ability to achieve symptom relief. Dyspnea crisis and dynamic hyperinflation can also occur among those with mild airflow obstruction (e.g., during exercise) as well as other causes of faster respiratory rate (e.g., during periods of anxiety).
Patients should be advised to contact their clinician if they experience fever, worsening of their respiratory status beyond usual day-to-day variation, and/or a significant increase in their production of purulent sputum. If patients are receiving systemic corticosteroids and are known to be diabetic, they should be advised to closely monitor their blood glucose and contact their clinician if it is outside the prescribed range. If patients are prescribed antibiotics, they should be advised to contact their clinician if they develop diarrhea, as antibiotic-associated colitis, which may be due to Clostridium difficile, is a recognized complication of exposure to antibiotics.
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