21.2. Acute exacerbation of COPD

Question 1

How do those with an exacerbation of COPD present?

Answer 1

Commonly present in winter
Increasing cough
Breathlessness
Wheeze
Decreased exercise capacity

Question 2

What should be asked while taking a history with someone who has had an exacerbation of their COPD?

Answer 2

Previous treatment (including home oxygen)
Smoking status
Exercise capacity

Question 3

What investigations can be done for an exacerbation of COPD?

Answer 3

ABG
CXR- exclude pneumothorax or infection
FBC, U&E, CRP. Theophylline level if patient on therapy at home
ECG
Send sputum or culture if purulent
Blood cultures if pyrexial

Question 4

What is involved in the immediate management of an exacerbation of COPD

Answer 4

Salbutamol and ipratropium nebulised

Oxygen therapy- 24-28% to get sats back to 88-92% with a less than 1.5kPa rise in carbon dioxide

IV hydrocortisone and oral prednisolone for 7-14d

Question 5

What other non pharmcological management may be useful?

Answer 5

Physiotherapy to aid sputum expectoration

Question 6

What is the next step after the triple drug treatment

Answer 6

Consider IV aminophylline (bronchodilator)

Question 7

What is the final stage before ventialtion?

Answer 7

Non invasive positive presure ventilation if RR>30 or pH<7.35

OR

Consider a respiratory stimulant drug such as doxapram