Acute Exacerbation of COPD

Definition and Onset of COPD Exacerbations

COPD exacerbation is defined as "an event in the natural course of the disease characterized by a baseline change in the patient's dyspnea, cough, and/or sputum that is beyond the normal day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD" 1
Exacerbations are trajectory-changing events in COPD that are comparable to myocardial infarctions in coronary artery disease - they are acute manifestations that can significantly impact disease progression 1

Approximately two-thirds of exacerbations are associated with respiratory tract infections or air pollution, which can trigger symptoms rapidly 1

Airway inflammation can increase significantly within hours of exposure to infectious or environmental triggers 2
The inflammatory response during exacerbations specifically includes increased lymphocytic inflammation in the airways, which can develop quickly 2

Initial management within the first 24 hours of an exacerbation should include measurement of arterial blood gas tensions, chest radiograph, full blood count, urea and electrolytes, and ECG 3
Nebulized bronchodilators should be administered promptly upon arrival and at 4-6 hourly intervals thereafter 3, 4
Monitoring should be vigilant, with repeat measurement of arterial blood gas tensions if the clinical situation deteriorates at any time 4

Failure to recognize the acute nature of COPD exacerbations may lead to delayed treatment, which can worsen outcomes 2