COPD Acute Exacerbation

Question 1

COPD Acute Exacerbation Definition

Answer 1

Sustained worsening of symptoms from usual stable state, beyond normal day-to-day variations and is acute

Question 2

COPD Acute Exacerbation Epidemiology

Answer 2

• Second most common cause of admission
• Usually caused by viral infection; tend to be more severe
• Also caused by bacteria, air pollutants and ambient temperature

Question 3

COPD Acute Exacerbation Most Common Virus?

Answer 3

Human rhinovirus

Question 4

COPD Acute Exacerbation Presentation

Answer 4

Acute deterioration of respiratory symptoms, particularly increased breathlessness and cough, increased sputum volume and/or change in sputum colour

• Malaise, reduced exercise tolerance, fluid retention, increased fatigue
• Respiratory failure

Question 5

COPD Acute Exacerbation Differentials

Answer 5

PE, pneumonia, upper airway obstruction, pneumothorax, CHF, lung cancer

Question 6

COPD Acute Exacerbation Ix

Answer 6

Sputum culture, bloods, blood culture, theophylline level if on theophylline, ABG, ECG, CXR,
-Functional testing not usually done

Question 7

COPD Acute Exacerbation Hospital Management

Answer 7

• Salbutamol 5mg/4h and Ipratropium 0.5mg/6h
• Controlled oxygen therapy
• IV hydrocortisone 200mg and oral prednisolone 30mg OD (continue for 7-14d)
• Antibiotics (amoxicillin or clarithromycin or doxycycline) usually not needed as most cases are viral
• Physio
• If no response, IV aminophylline
• If no response; 1. Consider NIPPV if RR>30 or pH <7.35 or PaC02 rising 2. Consider respiratory stimulant drug (e.g. doxapram) if unsuitable for ventilation
• Consider intubation and ventilation if pH <7.26 and PaCO2 rising

Question 8

COPD Acute Exacerbation Criteria for NIV

Answer 8

• Slow to wean from invasive ventilation

- Persistent hypercapnic ventilatory failure

Question 9

COPD Acute Exacerbation Prevention

Answer 9

Smoking cessation, pulmonary rehab, vaccination (influenze, pneumococcal), good control, prophylactic antibiotics