Investigations for Acute Exacerbations of COPD

Confirming the Diagnosis

The American Thoracic Society recommends that increased dyspnea is the key symptom of an exacerbation, often accompanied by increased sputum purulence and volume, increased cough, and wheeze 1
Clinical assessment should classify exacerbations as mild, moderate, or severe, with moderate exacerbations requiring short-acting bronchodilators plus antibiotics and/or oral corticosteroids, according to the American College of Chest Physicians 2
Severe exacerbations require hospitalization or emergency room visits, as stated by the American Thoracic Society 3

Chest radiography is essential to exclude pneumonia, pneumothorax, pulmonary edema, and lung cancer, as recommended by the American College of Radiology 1, 2, 4, 5
Differential diagnoses that must be excluded include acute coronary syndrome, worsening congestive heart failure, and pulmonary embolism, according to the American Heart Association 1, 2, 3

Assessment of previous exacerbation history, with frequency defined as two or more per year indicating high risk, is recommended by the Global Initiative for Chronic Obstructive Lung Disease 3
Evaluation of lung function parameters, with worse lung function increasing risk, is stated by the American Thoracic Society 1
CT imaging may identify increased ratio of pulmonary artery to aorta cross-sectional dimension and greater percentage of emphysema or airway wall thickness, as reported by the European Respiratory Society 3, 4

Arterial blood gas analysis is crucial in severe exacerbations to identify respiratory failure and assess need for oxygen therapy or ventilatory support, according to the American Thoracic Society 1
Blood tests to evaluate electrolytes for metabolic disturbances are recommended by the European Respiratory Society 5

Sputum culture and sensitivity are recommended to guide antibiotic therapy when purulent sputum is present, previous ineffective antibiotic treatment, or severe exacerbation requiring hospitalization, as stated by the American College of Chest Physicians 2
Oxygen saturation monitoring with target saturation of 88-92% for those at risk of hypercapnia is recommended by the American Thoracic Society 1

Spirometry is essential during follow-up assessment, as recommended by the European Respiratory Society 5
Evaluation of maintenance therapy adequacy to prevent future exacerbations is stated by the American Thoracic Society 1