From the Guidelines
A COPD exacerbation typically presents with worsening of respiratory symptoms beyond normal day-to-day variations, including increased dyspnea, increased sputum production, and change in sputum color, as noted in the most recent guideline from the American Academy of Family Physicians 1. The cardinal symptoms of a COPD exacerbation include:
- Increased dyspnea (shortness of breath)
- Increased sputum production
- Change in sputum color (often becoming more purulent or yellow-green) Patients may also experience:
- Worsening cough
- Chest tightness
- Wheezing
- Decreased exercise tolerance
- Fatigue Systemic manifestations can include:
- Fever, particularly with infectious triggers
- Signs of respiratory distress such as tachypnea (rapid breathing), use of accessory respiratory muscles, paradoxical abdominal movement, and in severe cases, cyanosis (bluish discoloration of lips or skin) Patients may demonstrate:
- Decreased oxygen saturation on pulse oximetry
- Altered mental status from hypoxemia or hypercapnia, depending on severity Laboratory findings might reveal:
- Leukocytosis
- Arterial blood gas analysis often shows worsening hypoxemia and potentially respiratory acidosis with hypercapnia in more severe cases These exacerbations are commonly triggered by:
- Respiratory infections (viral or bacterial)
- Air pollution
- Medication non-adherence and represent periods of acute deterioration that require prompt medical intervention to prevent further respiratory compromise, as emphasized in the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD 1.
From the Research
Clinical Presentation of COPD Exacerbation
The clinical presentation of a Chronic Obstructive Pulmonary Disease (COPD) exacerbation is characterized by:
- An increase in symptoms such as dyspnea, cough, and sputum production that worsens over a period of 2 weeks 2
- Changes in dyspnea, cough, and/or sputum production in a COPD patient 3, 4
- Acute worsening of symptoms, including dyspnea, cough and/or sputum production 5
Triggers and Causes
COPD exacerbations are mainly triggered by:
- Respiratory infections 5, 6
- Environmental factors 5
- Respiratory viruses and bacteria, which infect the lower airway and increase airway inflammation 6
Diagnosis and Management
Diagnosis of COPD exacerbation is clinical, based on changes in symptoms 3, 4 Management strategies include:
- Evidence-based interventions, such as appropriate use of antibiotics, bronchodilators, and corticosteroids 3, 4
- Noninvasive ventilation with capnography 3, 4
- Pharmacological interventions, such as inhaled steroids, long-acting bronchodilators, and their combinations 6
- Non-pharmacological therapies, such as pulmonary rehabilitation, self-management, and home ventilatory support 6