Acute exacerbation of COPD

Definition

• Worsening respiratory symptoms, including dyspnea, cough, sputum production, or change in sputum

Etiology

• Infections (bacterial or viral)
• Air pollution
• Pulmonary embolism
• Congestive heart failure

Differential Diagnosis

• Pneumonia
• Pulmonary embolism
• Heart failure

Clinical Manifestations

• History
• Signs & Symptoms

Investigations

• CXR r/o PNA
• ECG, troponins r/o ACS
• CBC
• ABG in severe exacerbation
• Sputum cultures to help guide later therapy
• Spirometry at some point during their hospitalization, if it's the first presentation

Management

• Puffers
  • Ipratropium; can transition later to tiotropium
  • MDI with aerochamber or nebulizer (no difference)
• Steroids
  • Prednisone 40mg for 5 days
• Antibiotics if purulent/sputum change
• Non-invasive ventilation
  • Decreases mortality and prevents intubation
  • Indicated if any of the following:
    • Respiratory acidosis (pH <7.35 and pCO2 >45)
    • Severe dyspnea with increased work of breathing
    • Resistant hypoxia despite supplemental oxygen

Prognosis

• 11% in-hospital mortality
• 23-33% 6-month or 1-year mortality
• 50% 2-year mortality