From the Guidelines
Lactate levels are not typically elevated in COPD exacerbations unless there are complications, such as significant hypoxemia or respiratory failure, as noted in the management of acute exacerbations of COPD 1. When managing COPD exacerbations, the primary focus is on symptom resolution and recovery from the exacerbation episode via improving airflow and gas exchange, as well as reducing lung inflammation, as outlined in the clinical practice guideline from the American Academy of Family Physicians 1. Some key points to consider in the management of COPD exacerbations include:
- The use of corticosteroids, systemic antibiotics, inhaled bronchodilators, and supplemental oxygen as typical interventions 1
- The potential role of mucolytics and aminophyllines in aiding in thinning and clearing of mucus and improving dyspnea, respectively 1
- The importance of nonpharmacologic treatments, such as pulmonary rehabilitation programs, chest physiotherapy, and nutritional supplements, in the management and prevention of COPD exacerbations 1 However, lactate elevation is not a direct consequence of COPD exacerbation, but rather may be indicative of underlying complications, such as sepsis or heart failure, that require prompt attention and further investigation 1. In the context of real-life clinical medicine, it is essential to prioritize the evaluation and management of potential complications and underlying conditions that may contribute to lactate elevation in COPD patients, rather than attributing the elevation solely to the COPD exacerbation itself 1.
From the Research
Lactate Levels in COPD Exacerbation
- Lactate levels are often elevated in patients with chronic obstructive pulmonary disease (COPD) exacerbations, as shown in a study published in 2018 2.
- Another study from 2023 found that approximately 50% of patients with COPD exacerbations had elevated lactate levels, which were not related to sepsis but rather to high cumulative doses of β2-agonists 3.
- Elevated lactate levels in COPD exacerbations have been associated with adverse clinical outcomes, such as tachypnoea, tachycardia, acidosis, and hyperglycaemia 3.
- A review of lactate level elevation published in 2013 highlighted that lactate levels can be elevated for many reasons, including tissue hypoperfusion, and that specific therapy may need to be tailored to the underlying cause of elevation 4.
Correlation with COPD Severity
- A study from 2009 found that increased obstruction in COPD was correlated with higher lactate concentrations and shorter distances walked in the six-minute walk test (6-MWT) 5.
- The same study found that the level of obstruction in COPD led to haemodynamic impairment, with increased heart rate at rest 5.
- Another study from 2018 found that lactate clearance can be evaluated as a useful marker in patients with COPD exacerbations, and that delta lactate value can determine the hospitalization need of patients 2.
Clinical Implications
- Elevated lactate levels in COPD exacerbations may indicate excessive β2-agonist treatment and should be investigated as a possible biomarker 3.
- Lactate monitoring in the emergency department has clinical benefits in addition to GOLD guidelines when deciding whether to discharge or hospitalize a patient with COPD exacerbation 2.
- Oxygen therapy in COPD exacerbations can be both helpful and harmful, and new guidance on its use has been published 6.