From the Guidelines
The clinical manifestations of a COPD exacerbation include worsening shortness of breath (dyspnea), increased cough, increased sputum production, and changes in sputum color (often becoming more purulent or yellow-green).
Clinical Manifestations
Patients typically experience greater difficulty breathing compared to their baseline, with increased wheezing, chest tightness, and use of accessory respiratory muscles.
- Decreased exercise tolerance and increased fatigue are common.
- Patients may develop tachypnea (rapid breathing) and tachycardia (rapid heart rate) as compensatory mechanisms.
- Hypoxemia can occur, manifesting as low oxygen saturation levels, cyanosis, or confusion in severe cases.
- Fever may be present if the exacerbation is triggered by infection.
Pathophysiology and Treatment
These symptoms represent an acute worsening beyond the patient's usual day-to-day variability and often result from respiratory infections, air pollution exposure, or medication non-adherence 1. The inflammatory response during exacerbations leads to increased airway obstruction, mucus hypersecretion, and gas exchange abnormalities, explaining the characteristic symptoms. Early recognition of these manifestations is crucial as prompt treatment with bronchodilators, corticosteroids, and antibiotics (when indicated) can prevent hospitalization and disease progression 1. According to recent guidelines, the management of COPD exacerbations should focus on symptom resolution, improving airflow and gas exchange, and reducing lung inflammation 1. Nonpharmacologic treatments, such as pulmonary rehabilitation programs, chest physiotherapy, and nutritional supplements, may also be beneficial in managing and preventing COPD exacerbations 1.
Prevention and Management
Prevention of acute exacerbations is also a key goal in the management of COPD, and may be achieved through the use of long-acting bronchodilators, inhaled corticosteroids, and other therapies 1. Overall, a comprehensive approach to the management of COPD exacerbations is necessary to improve patient outcomes and reduce the burden of this disease.
From the Research
Clinical Manifestations of COPD Exacerbation
The clinical manifestations of a COPD (Chronic Obstructive Pulmonary Disease) exacerbation include:
- Increased dyspnea (shortness of breath) [(2,3,4,5,6)]
- Increased cough [(2,3,4,5,6)]
- Increased sputum production [(2,3,4,5,6)]
- Increased sputum purulence [(2,3,4,5,6)]
- Worsening of symptoms that requires additional therapy [(2,3,4,5,6)]
Definition of COPD Exacerbation
A COPD exacerbation is defined as an acute or subacute worsening of symptoms, including dyspnea, cough, sputum production, and sputum purulence 6. The cardinal symptoms of a COPD exacerbation are nonspecific and can result from acute cardiorespiratory illnesses other than COPD 6.
Diagnostic Criteria
The diagnostic criteria for a COPD exacerbation include:
- Oxygen desaturation ≤4% below that of stable state 6
- Elevated levels of circulating blood neutrophils or eosinophils (≥9000 neutrophils·mm-3 or ≥2% blood eosinophils) 6
- Elevated C-reactive protein (≥3 mg·L-1) 6
- No evidence of pneumonia or pulmonary oedema on chest radiography 6
- Negative laboratory test results for other aetiologies 6
Treatment
The treatment of COPD exacerbation includes:
- Inhaled short-acting bronchodilators [(3,5)]
- Systemic glucocorticoids [(3,4)]
- Antibiotics [(3,4)]
- Noninvasive mechanical ventilation (NIV) [(2,5)]
- Oxygen therapy [(2,5)]