acute exacerbation of COPD

Question 1

common triggers

Answer 1

May be triggered by viral or

bacterial infections.

Question 2

Presentation

Answer 2

Increasing cough, breathlessness, or wheeze. Decreased exercise
capacity.

Question 3

History

Answer 3

Ask about usual/recent treatments (especially home oxygen), smoking
status, and exercise capacity (may infl uence a decision to ventilate the patient).

Question 4

Differential diagnosis

Answer 4

Asthma, pulmonary oedema, upper respiratory tract obstruction,
pulmonary embolus, anaphylaxis.

Question 5

Investigations

Answer 5

Arterial blood gases (p785).
• CXR to exclude pneumothorax and infection.
• FBC; U&E; CRP. Theophylline level if patient on therapy at home.
• ECG.
• Send sputum for culture if purulent.
• Blood cultures if pyrexial.

Question 6

Management

Answer 6

Look for a cause, eg infection, pneumothorax.
• See below for acute management.
• Prior to discharge, liaise with GP regarding steroid reduction, domiciliary oxygen
(p176), smoking cessation, and pneumococcal and fl u vaccinations (p160).

1 - Nebulized bronchodilators
Salbutamol 5mg/4h and ipratropium 500μg/6h
Investigate: CXR, ABG

2 - Controlled oxygen therapy if SaO2 8.0kPa with a rise in PaCO2 30 or pH <7.26 and PaCO2 is
rising despite non-invasive ventilation

9 - 3 Consider a respiratory stimulant drug, eg doxapram 1.5–4mg/
min IV. SE: agitation, confusion, tachycardia, nausea. In patients who are not suitable for mechanical ventilation. It is
a short-term measure, used only if NIV is not available