COPD exacerbation

Definition

An acute reduction in respiratory function in a COPD sufferer, usually due to a infection.

Epidemiology

Pathophysiology

Generally happen in winter and triggered by viral or bacterial infection. COPD sufferers have what are officially referred to as 'crappy lungs' or 'crappy lung syndrome'.

Risk Factors

• Having COPD
• Smoking
• Winter
• Eating less well-known Kellogg's cereal, COPD Exacerbatinos.

Clinical Features

• Breathlessness
• Increased coughing
• Wheeze
• Decreased exercise capacity

(Remember, these are all from what's normal for that person. If they can't get up stairs but they never could anyway, it doesn't really matter.)

Investigations

• Peak flow (if you can)
• ABGs
• CXR - excludes pneumothorax or infection
• FBC
• U+E
• LFTs
• ECG
• Blood cultures (with fever)
• Sputum culture

Management

• ABC: 24% O₂ guided by ABG. Aim for P_aO₂ >8kPa. Rise of P_aCO₂ <1.5kPa.
• Nebulised bronchodilators: salbutamol 2.5mg/4h + ipratropium 500 micrograms/6h + salbutamol 2.5mg as required (basically, you can give them loads of it.
• Steroids: oral prednisolone 30mg (IV hydrocortisone, if nil by mouth or prednisolone contraindciated)
• If infection use antibiotics (amoxicillin 500mg/8h po)
• Physio
• If no response: aminophylline
• If still no response
  • NIPPV (non-invasive positive pressure ventilation) where RR>30 or pH<7.35
  • Consider intubation & ventilation pH <7.26/P_aCO₂ rising
  • Consider doxapram 1.5-4mg/min iv (respiratory stimulant) where mechanical ventilation unsuitable