From the Guidelines
In acute COPD exacerbation, I typically order a chest X-ray (posteroanterior and lateral views) as the primary imaging study to rule out pneumonia, pneumothorax, or other complications, as recommended by the American College of Radiology 1.
Laboratory and Radiology Studies
The following studies are recommended:
- Chest X-ray (posteroanterior and lateral views) to evaluate for comorbidities, complications, and alternative diagnoses 1
- Complete blood count to assess for leukocytosis suggesting infection
- Basic metabolic panel to evaluate electrolyte imbalances and kidney function
- Arterial blood gas analysis to determine the severity of respiratory compromise and acid-base status
- Sputum culture if bacterial infection is suspected
- Electrocardiogram to rule out cardiac causes
- Pulse oximetry for continuous oxygen saturation monitoring
Additional Considerations
In severe cases or when the diagnosis is unclear, a CT scan of the chest may be considered to evaluate for pulmonary embolism, bronchiectasis, or other pathologies not visible on plain radiographs, as suggested by the management of acute exacerbations of chronic obstructive pulmonary disease study 1.
Management
These studies help determine the severity of the exacerbation, identify potential triggers, rule out alternative diagnoses, and guide appropriate management including bronchodilator therapy, systemic corticosteroids, antibiotics if indicated, and oxygen supplementation.
From the Research
Land Studies in Acute COPD Exacerbation
- A study published in the Journal of Clinical Medicine in 2023 2 found that patients with acute COPD exacerbation underwent various land studies, including:
- Measurement of respiratory rate upon presentation (73% of patients)
- Blood gas analysis (70% of patients)
- Spirometry (10% of patients)
- Another study published in the International Journal of Chronic Obstructive Pulmonary Disease in 2021 3 recommended the following land studies for patients with acute COPD exacerbation:
- Full blood count
- Renal function tests
- C-reactive protein measurement
- Cardiac blood biomarkers (BNP and troponin)
Radiology Studies in Acute COPD Exacerbation
- A study published in the Journal of Clinical Medicine in 2023 2 found that 94% of patients with acute COPD exacerbation received chest imaging
- The type of radiology study was not specified in the study, but it is likely that chest X-rays or computed tomography (CT) scans were used to evaluate the patient's lung function and detect any potential complications
- Another study published in the Emergency Medicine Practice in 2017 4 mentioned the use of capnography in noninvasive ventilation, but did not provide specific information on radiology studies
Other Diagnostic Tests
- A study published in the Multidisciplinary Respiratory Medicine in 2018 5 discussed the use of various diagnostic tests, including:
- Arterial blood gas analysis
- Pulse oximetry
- Electrocardiogram (ECG)
- A study published in the Revue des Maladies Respiratoires in 2010 6 recommended the use of:
- D-dimer test to rule out pulmonary embolism
- Echocardiogram to evaluate cardiac function
- Sleep study to diagnose sleep apnea, if suspected