Chronic Obstructive Pulmonary Disease (COPD) – Acute Exacerbation

Pathology:

Acute deterioration beyond the normal day-to-day variation in a COPD patient's physiological state.

Aetiology:

Upper respiratory tract infection (URTI) caused by a virus, lower respiratory tract infection (LRTI) resulting from bacterial infection, and non-infective sources such as air pollution, chronic heart failure, pulmonary embolism, and myocardial infarction (MI) all contribute to the onset of acute exacerbation of COPD.

Symptoms:

• Breathlessness
• Cough
• Purulent sputum
• Decreased exercise tolerance

Signs:

• Increased respiratory rate
• Respiratory distress
• Confusion
• Cyanosis

Investigations:

• Bloods: Full Blood Count (FBC), electrocardiogram (ECG), Urea and Electrolytes (U&E), C-reactive protein (CRP), Blood cultures, and Theophylline.
• Arterial Blood Gas (ABG): Test to assess signs of respiratory failure.
• Chest X-Ray: Test to assess for source of infection.
• ECG: Test to rule out myocardial infarction (MI).
• Sputum Culture: Test to aid in selection of antibiotic.

Treatment:

Treatment for acute exacerbations of COPD includes oxygen, oral steroids, antibiotics, nebulizers, and non-invasive ventilation. If an ABG test reveals only hypoxia, the patient may be treated with continuous positive airway pressure (CPAP); whereas if the test reveals both hypoxia and hypercapnia, the patient may be treated with BIPAP.

Complications:

• Decreased mobility
• Deterioration in lung function
• Mechanical ventilation
• Death

Prognosis:

Approximately 10-20% of COPD patients admitted for acute exacerbation will die within 3 months.

Figure 2.6 First Line Treatments For Acute Exacerbation of COPD