← Diagnosis and Management Guides
COPD Exacerbation
Key considerations: Pneumonia, PE, Pneumothorax
Cannot miss
- Pneumonia
- PE
- Pneumothorax
- Acute heart failure
Likely diagnoses
- Viral infection trigger
- Bacterial exacerbation
- Non-adherence to meds
Red flags
- Altered mental status
- Respiratory acidosis
- Cyanosis
Workup
- history: Baseline dyspnea level, sputum changes, medication compliance; exam: Wheezing, prolonged expiration, accessory muscle use; labs: ABG/VBG, CBC, BMP, procalcitonin; BNP if CHF suspected; imaging: CXR: hyperinflation, infiltrate, effusion; bedside: SpO2 target 88-92%
Management
- immediate: Albuterol/ipratropium nebs; Prednisone 40mg x5 days; Antibiotics if purulent sputum (azithromycin or doxycycline); general: BiPAP for moderate-severe respiratory distress; Avoid excessive O2 (CO2 retention risk)
Disposition
- admit: Respiratory failure, need for BiPAP, severe acidosis; discharge: Improved with treatment, able to manage at home; consults: Pulmonology for frequent exacerbations
Clinical pearls
- GOLD: short course steroids (5 days) as effective as longer courses
- BiPAP reduces intubation rates by 60%
Source and review
- GOLD 2024. Last reviewed: 2024-11-01