Treatment of acute exacerbations

COPD management involves treatment of chronic stable disease and of exacerbations.¹ Treatment of acute COPD exacerbations aims to ensure adequate oxygenation and near-normal blood pH, reverse airway obstruction, and treat any underlying cause.

The underlying cause of an acute exacerbation is usually unknown, although most acute exacerbations result from bacterial or viral infections. Smoking, irritative inhalational exposure, and high levels of air pollution also contribute.

• Mild exacerbations can often be treated on an outpatient basis or self managed

• Patients with comorbidities, a history of respiratory failure, or acute changes in arterial blood gas measurements are admitted to hospital for observation and treatment

• Patients with life-threatening exacerbations manifested by uncorrected moderate to severe acute hypoxemia, acute respiratory acidosis, new arrhythmias, or deteriorating respiratory function despite hospital treatment should be admitted to the ICU and their respiratory status monitored frequently

Figure 1: Causes of exacerbations.

Reference

1. Global Initiative for chronic obstructive lung disease: Global strategy for the diagnosis, management, and prevention of COPD. 2010. www.goldcopd.org