Clinical meaning
AECOPD is defined as an acute worsening of respiratory symptoms beyond normal day-to-day variation requiring a change in therapy. Exacerbations are classified as mild (managed with increased bronchodilators), moderate (requires systemic corticosteroids and/or antibiotics), or severe (requires hospitalization or ED visit). The most common triggers are viral respiratory infections (50-60%), bacterial infections (40-50%, predominantly H. influenzae, M. catarrhalis, S. pneumoniae), and environmental pollutants. Exacerbations accelerate FEV1 decline, reduce quality of life, and increase mortality (in-hospital mortality for severe exacerbations is 3-10%). The clinician must prescribe a short course of systemic corticosteroids (prednisone 40mg daily x 5 days) and antibiotics when purulent sputum is present or ventilatory support is required.
Diagnosis & workup
Diagnostics & workup: - ABG if moderate-severe exacerbation (assess for respiratory acidosis and hypercapnia) - CBC to assess WBC and eosinophil response - CXR to exclude pneumonia, pneumothorax, or pleural effusion - Sputum culture if purulent sputum and failure of initial antibiotics - ECG to rule out arrhythmia or right heart strain - BNP/NT-proBNP if cardiac decompensation suspected