Presenting features of acute exacerbations
Exacerbations in patients may differ widely. Some patients may have mild episodes which are usually managed at home while some may face life-threatening events necessitating ventilatory support and a prolonged hospital stay. (1,2)
There is no single defining symptom of an exacerbation.
- worsening of previous stable condition
- increased wheeze
- increased dyspnoea
- increased sputum volume
- increased sputum purulence
- chest tightness
- fluid retention
- reduced exercise tolerance
- increased fatigue
Chest pain and fever are uncommon and if present should prompt a search for other aetiologies.
The following signs can be considered as signs of a severe exacerbation:
- marked dyspnoea
- tachypnoea
- purse lip breathing
- use of accessory muscles (sternomastoid and abdominal) at rest
- acute confusion
- new onset cyanosis
- new onset peripheral oedema
- marked reduction in activities of daily living
Reference:
- National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. Jul 2019 [internet publication].
- Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2025 report. 2025 [internet publication].
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