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)

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 (1)

Chest pain and fever are uncommon and if present should prompt a search for other aetiologies (1).

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 (2)

Reference:

• (1) Currie, G.P. (Ed.) (2011) ABC of COPD. Oxford: Blackwell Publishing
• (2) National Institute for Health and Clinical Excellence (NICE) 2018. Chronic obstructive pulmonary disease in over 16s: diagnosis and management.