This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Go to /pro/cpd-dashboard page

This page is worth 0.05 CPD credits. CPD dashboard

Go to /account/subscription-details page

This page is worth 0.05 CPD credits. Upgrade to Pro

Infective exacerbations of COPD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

An exacerbation can be defined as a sustained worsening of the patient's symptoms from his or her usual stable state that is beyond normal day-to-day variations, is acute in onset and requires additional therapy.

  • worsening breathlessness is the key symptom of an exacerbation
    • other symptoms include - increased sputum production and change in sputum colour together with increased cough and wheeze (1,2)

A number of factors have been identified as the cause of exacerbation of COPD:

  • the cause may be unidentified in around 30% of exacerbations
  • infections -
    • viruses - rhinoviruses (common cold), RSV, influenza, parainfluenza,
    • bacteria - H influenza, S pneumonia, staph aureus,
  • common pollutants - nitrogen dioxide, sulphur dioxide, particulates (1)

Exacerbations can be classified as (1)

  • mild - can be controlled with an increase in dosage of regular medications
  • moderate - requires treatment with systemic corticosteroids or antibiotics
  • severe - requires hospitalization or evaluation in the emergency department (may also be associated with acute respiratory failure) (2)
  • factors which favour treatment in hospital

    • not able to cope at home

    • severe beathlessness

    • general condition is poor/ deteriorating

    • level of activity is poor/confined to bed

    • cyanosis is present

    • worsening peripheral oedema

    • impaired level of consciousness

    • patients is already receiving long term oxygen therapy

    • patient is living alone/ not coping

    • acute confusion is present

    • exacerbation has had a rapid rate of onset

    • there is significant comorbidity particularly cardiac disease and insulin-dependent diabetes)

    • SaO2 < 90%

    • changes on the chest radiograph are present

    • arterial pH level < 7.35

    • arterial PaO2 < 7 kPa

For further details the consult the full guideline (1).

Reference:


Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.