6. Chronic Obstructive Pulmonary Disease (COPD) Acute Exacerbation

Question 1

COPD includes ___

Answer 1

emphysema, asthma, and bronchitis.

Question 2

In general, with each type of COPD, it is easier for air to ___

Answer 2

enter the pulmonary system than to exit it; inspiration is easier than exhalation

Question 3

Physiological consequences of COPD include:

Answer 3

-Dynamic hyperinflation occurs due to too much air in the lungs.
-Air trapping and auto-PEEP are common.
-Expiratory flow rates are LOW.
-An acute exacerbation results in a V/Q mismatch due to a problem with ventilation and an increase in the PaCO2.
-The pt may have chronic CO2 retention; if so, the pt will have partial or complete compensation and high HCO3 on the ABG.
-COPD may result in right ventricular enlargement (cor pulmonale) and elevated CVP.

Question 4

Signs of an acute exacerbation of COPD include:

Answer 4

-Worsening dyspnea
-Increase in sputum purulence
-Increase in sputum volume
-Hypercapnia, hypoxemia

Question 5

Management of an acute exacerbation of COPD includes:

Answer 5

-Titrate FiO2 to PaO2 > 60 mmHg or SaO2 > 90% with care not to overcorrect hypoxemia and decrease respiratory drive
-Must address SEVERE hypoxemia; do not withhold
oxygen only because hypoventilation may
occur…cells still need oxygen

-Bronchodilator therapy
-Inhaled short-acting beta-agonist (SABA), e.g.
albuterol
-Inhaled anticholinergic

-Monitor the level of consciousness for decreased responsiveness (clinical sign of worsening hypercapnia)

-Corticosteroid therapy

-Antibiotic therapy (when pneumonia is thought to be the trigger)

-Proceed with mechanical ventilatory support if needed (noninvasive or invasive).
-Multiple studies have shown that noninvasive ventilation (NIV) is beneficial for pts with an acute exacerbation of COPD.