View source for Acute exacerbation of COPD

<section begin="A&IC" />'''Acute exacerbations of COPD''' are acute worsenings of symptoms in a patient with [[Chronic obstructive pulmonary disease|COPD]]. It may be caused by viral respiratory infections, bacterial infections, pollution, or stress.

Exacerbations may vary in intensity from mild to very severe and life-threatening. Rapid assessment of the severity is important.

== Clinical features ==
The cardinal symptoms of acute exacerbations are worsening dyspnoea, worsening cough, increased volume and/or purulence of sputum. In severe cases, respiratory failure may occur. If [[respiratory failure]] occurs, or if symptoms are severe, or if the patient has serous comorbidities, or if out-patient treatment has failed to improve symptoms, hospitalization is needed.

== Diagnosis and evaluation ==
The diagnosis is based on clinical symptoms of respiratory distress, dyspnoea, and evidence of lower airway obstruction on auscultation (expiratory wheezing, prolonged expiration). If there are severe symptoms, [[ABG]] is used to assess the level of severity.

== Treatment ==
In most cases, an increased dose of inhaled [[bronchodilators]] is necessary along with a short course of an oral [[corticosteroids]] like prednisolone. In Norway, [[ipratropium]] and [[salbutamol]] are usually administered in a nebulizer 4 times daily for the duration of the exacerbation.

If a bacterial infection is suspected, due to infectious signs or purulent or increased volume of sputum, empiric antibiotics can be given.

In cases more severe cases with [[respiratory failure]], [[O2 supplementation|O2 supplement]] or [[non-invasive ventilation]] is used. In very severe cases, [[Intensive care unit|ICU]] admission and [[invasive ventilation]] is necessary. Admission to the ICU is indicated if:

* If conservative therapy doesn’t work
* PaO2 < 40 mmHg
* pH < 7,25
* Haemodynamic instability
<section end="A&IC" />
[[Category:Intensive care]]
[[Category:Pulmonology]]