Adult Guidance
Exacerbation of Chronic Obstructive Pulmonary Disease

Exacerbation of Chronic Obstructive Pulmonary Disease

Definition

Acute worsening of patient's respiratory symptoms beyond normal day-to-day variations that results in additional therapy in patients with underlying chronic obstructive pulmonary disease (COPD)

COPD refers to a group of diseases that block airflow and impair breathing and includes emphysema and chronic bronchitis

Diagnosis

Recent and sustained worsening of dyspnea and cough with increased sputum production compared to the baseline in a patient with COPD

Important: Symptoms can overlap with pneumonia (pneumonia more likely if tachycardia, tachypnea at rest and crepitations that persist after coughing are present)

Usually not needed but to be considered in severe cases; the respiratory tract of people with COPD may be colonized with bacteria (e.g. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa, Stenotrophomonas maltophilia) and a positive culture may indicate colonization rather than acute infection

Consider C-reactive protein and/or procalcitonin, complete blood count, and blood pH and gases

Consider a chest radiograph in patients requiring hospitalization to exclude other diagnoses and in outpatients if pneumonia suspected

Microbiology

Prevention

Recommend smoking cessation, reduced indoor air pollution, use of long-acting inhaled β₂-agonists (± anticholinergics) and vaccination (e.g. against influenza, Streptococcus pneumoniae and SARS-CoV-2)

Treatment

Antibiotics are not needed for most cases

  • Their use could be considered in patients with dyspnea and an increased volume of purulent sputum
  • In case of frequent exacerbations consider risk of infections caused by multidrug-resistant pathogens and previous colonization of the respiratory tract

Additional Information

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