From the Guidelines
For a COPD exacerbation assessment, I recommend a systematic approach focusing on severity determination and prompt intervention, as outlined in the 2017 European Respiratory Society/American Thoracic Society guideline 1.
Assessment Criteria
The assessment criteria for COPD exacerbation include:
- Increased dyspnea
- Cough
- Sputum production (volume and purulence)
- Vital signs, including oxygen saturation
Diagnostic Tests
Diagnostic tests that should be ordered include:
- Arterial blood gases
- Chest X-ray
- Complete blood count
- Sputum culture if infection is suspected
Classification of Exacerbations
COPD exacerbations can be classified as:
- Mild (treated with short-acting bronchodilators only) 1
- Moderate (treated with short-acting bronchodilators plus antibiotics and/or oral corticosteroids) 1
- Severe (patient requires hospitalization or visits the emergency room) 1
Treatment
Treatment should include:
- Bronchodilators (short-acting beta-agonists like albuterol 2.5mg via nebulizer or 4-8 puffs via MDI every 4-6 hours, and anticholinergics like ipratropium 0.5mg via nebulizer or 4-8 puffs via MDI every 4-6 hours)
- Systemic corticosteroids - prednisone 40mg daily for 5 days is typically sufficient 1
- Antibiotics such as amoxicillin-clavulanate 875/125mg twice daily, doxycycline 100mg twice daily, or azithromycin 500mg on day 1 followed by 250mg daily for 4 days for suspected bacterial infections
- Supplemental oxygen to maintain saturation between 88-92%
Hospitalization
Severe exacerbations may require hospitalization, especially with respiratory failure, significant comorbidities, or inadequate home support 1. The 2017 Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease report also provides guidance on the management of COPD exacerbations, including the use of noninvasive mechanical ventilation and pulmonary rehabilitation 1. The American College of Chest Physicians and Canadian Thoracic Society guideline on the prevention of COPD exacerbations provides additional guidance on the prevention of exacerbations, including the use of pharmacologic and nonpharmacologic interventions 1.
From the Research
Assessment Criteria for COPD Exacerbation
The assessment criteria for Chronic Obstructive Pulmonary Disease (COPD) exacerbation include:
- Increase in sputum purulence
- Increase in sputum volume
- Worsening of dyspnea 2 These criteria are widely accepted and used to diagnose COPD exacerbations.
Diagnostic Tests
Diagnostic tests for COPD exacerbation include:
- Baseline chest radiography
- Arterial blood gas analysis 2 These tests help to assess the severity of the exacerbation and guide treatment.
Treatment Options
Treatment options for COPD exacerbation include:
- Bronchodilators, such as short-acting beta-agonists and anticholinergics 3, 2
- Corticosteroids, which have been shown to improve outcomes during an acute COPD exacerbation 2, 4
- Antibiotics, which are beneficial for patients with severe exacerbation 2, 4
- Noninvasive positive pressure ventilation, which may benefit patients with rapid decline in respiratory function and gas exchange 2, 5
Patient Management
Patient management for COPD exacerbation includes:
- Identifying patients at risk of exacerbations and managing them appropriately to reduce this risk 6
- Maximizing bronchodilation as an initial strategy to reduce exacerbation risk 6
- Considering the addition of inhaled corticosteroids, phosphodiesterase inhibitors, or macrolide antibiotics for patients who continue to experience exacerbations despite maximal bronchodilation 6