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, and is acute in onset.
- 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 breathlessness
- 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 chest radiograph
- arterial pH level < 7.35
- arterial PaO2 < 7 kPa
For further details, consult the full guideline (1).
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