COPD Exacerbation

Question 1

Features of an acute exacerbation of COPD?

Answer 1

Increased dyspnoea – particularly on exertion
Increased sputum volume/purulence.
Increased cough
Upper airway symptoms (e.g. colds and sore throats)
Increased wheeze
Chest tightness
Reduced exercise tolerance
Fluid retention
Increased fatigue
Acute confusion
Worsening of a previously stable condition

Question 2

Severe features of acute exacerbation of COPD?

Answer 2

Marked dyspnoea
Tachypnoea
Pursed-lips breathing
Use of accessory respiratory muscles (sternomastoid and abdominal) at rest.
Acute confusion
New-onset cyanosis
New-onset peripheral oedema
Marked reduction in activities of daily living

Question 3

Differentials to acute COPD exacerbation?

Answer 3

Asthma.
Pneumonia.
Pneumothorax.
Left ventricular failure/pulmonary oedema.
Pulmonary embolus.
Lung cancer.
Upper airway obstruction.
Pleural effusion.
Recurrent aspiration.

Question 4

management of COPD exacerbation pt

Answer 4

5mg salbutamol & 500mcg ipratropium bromide nebulised with 6 l/min oxygen, limit to 6 minutes at a time if needed

Further does of salbutamol if required

Discuss prednisolone PGD as a potential

Consider use of hydrocortisone, steroid, to suppress inflammation and immune response