COPD: Exacerbations


  • COPD patients suffer from chronic and damaged airways the constrict and swell following certain triggers, infection being the most frequent one. Others include allergens, irritants and other chronic diseases such as CHF, DM and PE.
  • Even though most of the time they are fine with their chronic meds, sometimes they get worse. More coughing, sputum and dyspnea appear. This is called an “exacerbation”.
  • Severe COPD patients will have more frequent and worse exacerbations. The fact there has been previous ones or hospitalization due to an exacerbation means the current one must be handled carefully and maybe aggressively.
  • When examination gives clues of lung infection like rales and egophony, or if vitals are altered and constitutional symptoms are present, you may want to exclude pneumonia. Get a bloodwork, chest xray and if ox sat is below 88 or acidosis is suspected get an arterial blood gas.
  • Mental status may be affected which may mean severe acidosis from hypoxemia and hypercapnia. It may also mean infection in a 75 year old with no fever.
  • The approach is simple: Bronchodilators, steroids, oxygen supply (keep o2 sat between 88-92 specially in severe COPD patients) and antibiotics if infection is strongly suspected.
  • Remember severe COPD patients “need” a certain amount of CO2 because they are so tolerant to it so intense oxygen therapy in them may be harmful. Keep O2sat between 88 and 92%. That’s enough.
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-The Plague Doctor

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