A COPD exacerbation is an acute worsening of breathlessness, cough or sputum beyond the patient's usual day-to-day changes. Most are triggered by viral or bacterial infections, and a severe flare can lead to respiratory failure.
Key symptoms
- More shortness of breath than usual
- More cough and more sputum, often thicker or green
- Wheeze and chest tightness
- Fatigue, poor sleep and trouble with daily activities
What you find on exam
- Fast breathing, pursed lips, use of neck muscles
- Wheeze or reduced breath sounds; a quiet chest is a danger sign
- Oxygen saturation, heart rate, temperature
- Drowsiness, confusion or cyanosis suggest high carbon dioxide
- Signs of right heart strain: leg edema, raised jugular venous pressure
Tests
- Oxygen saturation, with a target of 88 to 92 percent
- Blood gas if severe, drowsy or on oxygen: checks carbon dioxide and pH
- Chest X-ray: pneumonia, pneumothorax, heart failure
- ECG, blood count, electrolytes; sputum culture if severe or recurrent
Treatment basics
- Controlled oxygen to 88 to 92 percent; avoid giving too much
- Inhaled albuterol with ipratropium, by nebulizer or inhaler with spacer
- Oral prednisone for about 5 days
- Antibiotics if sputum is purulent or the patient needs ventilation
- Noninvasive ventilation (BiPAP) for acidosis from high carbon dioxide
Red flags
- Drowsiness, confusion or a slowing breathing rate
- Low saturation despite oxygen, or pH under 7.35 on blood gas
- Cannot speak in sentences, chest pain or new arrhythmia
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Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.