Assessment
Acute Exacerbations of COPD ÎAn acute exacerbation is a sustained worsening of dyspnea, cough, or sputum production leading to an increase in the use of maintenance medications and/or supplementation with additional medications. It is further classified as purulent or nonpurulent.
ÎThe most common causes of an exacerbation are infection and air pollution, but the cause of about one-third of severe exacerbations cannot be identified (B).
ÎAcute exacerbations are the most frequent cause of medical visits, hospital admissions, and death among COPD patients.
ÎAcute exacerbations are preventable with optimal management of COPD.
ÎTreatment with a long-acting inhaled anticholinergic drug reduces the rate of COPD exacerbations and improves the effectiveness of pulmonary rehabilitation.
ÎNoninvasive mechanical ventilation in exacerbations improves respiratory acidosis, increases pH, decreases the need for endotracheal intubation, and reduces PaCO2
of hospital stay and mortality (B). ÎExacerbations with signs of infection may benefit from antibiotic treatment (B).
ÎA diagnosis of pulmonary embolism should be considered in patients with exacerbation severe enough to warrant hospitalization, especially in those with an intermediate-to-high pretest probability of pulmonary embolism.
Table 1. Classifications of Chronic Obstructive Pulmonary Disease Classification
Symptoms (Medical Research Council Dyspnea Scale)
Mild Moderate Severe Very severe
Shortness of breath from COPD when hurrying on the level or walking up a slight hill (MRC 2)
Shortness of breath from COPD causing the patient to stop aſter walking about 100 m (or aſter a few minutes) on the level (MRC 3-4). Average < 1 AECOPD/yr
Shortness of breath from COPD resulting in the patient too breathless to leave the house, breathlessness aſter dressing/undressing (MRC 5). Average ≥ 1 AECOPD/yr
Chronic respiratory failure or clinical signs of right heart failure
FEV1 FEV1
/FVC ratio < 0.70 ≥ 80% predicted
50% ≤ FEV1 FEV1 /FVC ratio < 0.70 30% ≤ FEV1
FEV1 FEV1
/FVC ratio < 0.70 , respiratory rate, severity of breathlessness, the length
Spirometric Definition FEV1
< 80% predicted < 50% predicted
< 50% predicted with symptoms
/FVC ratio < 0.70 < 30% predicted OR
