Chronic Obstructive Pulmonary Disease (COPD) – Acute Exacerbation

Chronic Obstructive Pulmonary Disease (COPD) – Acute Exacerbation

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


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.


  • Breathlessness
  • Cough
  • Purulent sputum
  • Decreased exercise tolerance


  • Increased respiratory rate
  • Respiratory distress
  • Confusion
  • Cyanosis


  • 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 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.


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


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

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