A COPD exacerbation is an acute worsening of breathlessness, cough or sputum beyond the patient's usual day-to-day changes, most often triggered by a viral or bacterial infection. Many flares can be managed at home, and good treatment helps prevent hospital stays and further lung decline.
Key symptoms
- More shortness of breath than usual
- More cough and more sputum
- Sputum that turns yellow or green
- Wheeze, chest tightness, fatigue
What you find on exam
- Respiratory rate, heart rate and oxygen saturation
- Wheeze, poor air entry, pursed-lip breathing, use of accessory muscles
- Confusion or drowsiness that suggests carbon dioxide retention
- Signs of pneumonia, heart failure or leg swelling
Tests
- Pulse oximetry; target saturation 88 to 92 percent
- Chest X-ray to look for pneumonia, pneumothorax or heart failure
- Viral testing when it changes treatment
- Arterial or venous blood gas if severe; spirometry is not done during the flare
Treatment basics
- Short-acting bronchodilators: albuterol with or without ipratropium
- Oral prednisone 40 mg for 5 days
- Antibiotics if sputum is more purulent, such as doxycycline or azithromycin
- Check inhaler technique and maintenance therapy; smoking cessation
- Follow up within days; pulmonary rehab and vaccines after recovery
Red flags
- Oxygen saturation below 88 percent despite treatment
- Confusion, drowsiness or severe breathlessness at rest
- Failure of outpatient treatment or serious coexisting illness
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.