Investigation of exacerbation of COPD

Diagnosis of an exacerbation is usually made clinically. In patients who have their exacerbation managed in primary care:

• sending sputum samples for culture is not recommended in routine practice
• pulse oximetry is of value if there are clinical features of a severe exacerbation

In all patients with an exacerbation referred to hospital

• a chest radiograph should be obtained
• arterial blood gas tensions should be measured and the inspired oxygen concentration should be recorded
• an ECG should be recorded (to exclude comorbidities)
• a full blood count should be performed and urea and electrolyte concentrations should be measured
• measure theophylline level on admission in people who are taking theophylline therapy
• if sputum is purulent, a sample should be sent for microscopy and culture
• blood cultures should be taken if the patient has pyrexia (1)

Reference:

• (1) National Institute for Health and Clinical Excellence (NICE) 2018. Chronic obstructive pulmonary disease in over 16s: diagnosis and management.