infective exacerbations of COPD

Last edited 12/2018 and last reviewed 12/2018

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).