Introduction

Chronic Obstructive Pulmonary Disease (COPD) is characterised by irreversible airflow obstruction which can be acutely exacerbated. While two distinct phenotypes exist, either dominated by chronic bronchitis or emphysema, the acute management of an exacerbation is the same regardless.

The single biggest risk factor for COPD is smoking, though environmental exposures and air pollution also play a part. The incidence of COPD typically increases with age.

Most exacerbations of COPD are caused by a bacterial or viral lower respiratory tract infection thought some are non-infectious in origin and may be caused by environmental triggers.

Long term management of COPD includes short and long acting beta agonists , muscarinic antagonists and inhaled corticosteroids in various combinations as dictated by the patient’s baseline pulmonary function and symptoms. Patients may also have nebulised short acting bronchodilators at home for regular or occasional use. In patients with severe disease, long term oxygen therapy (LTOT) at home is often used either continuously or intermittently.

The chronic management of COPD is beyond the scope of this article, however it is important to be aware of the long-term management of COPD in making decisions regarding the acute management of an exacerbation of COPD. Many hospitals and community health units will have a COPD outreach programme which aims to manage patients with COPD in the community insofar as possible.

Clinical Features

Typical symptoms of COPD include dyspnoea, cough & sputum production. In an acute exacerbation, these symptoms are likely to worsen or change in nature, e.g. increased sputum production with a change in colour. Infectious exacerbations may also present with fever, rigors or malaise.

Patients may require supplemental oxygen to maintain oxygen saturations or for patients on LTOT, they may have an increased oxygen requirement.

Differential Diagnosis