Abstract
Lxacerbation of COPD is defined as an event in the course of the disease which is characterized by changes of usual dyspnoea, cough and/or expectoration exceeding the normal daily fluctuations. Its onset is sudden and it may justify alterations in established treatment of COPD patients.
Most commonly, exacerbations are due to infections of the tracheobronchial tree. Approximately 10 percent of exacerbations are caused by air pollution.
In about one third of severe exacerbations, the cause cannot be determined. Exacerbations give rise to bronchospasm, oedema of the bronchial mucosa and stagnation of mucus.
As a result of the usual primary thickening of the bronchial wall, resistance increases significantly. Areas with a low ventilation/perfusion ratio develop.
Both hyperinflation and intrinsic positive end-expiratory pressure (iPEEP) increase. The main symptom of exacerbation is breathlessness, often accompanied by wheezing and chest pressure, increased cough and sputum production, changes in sputum colour or viscosity, and a temperature.
Exacerbations may also be manifested by numerous uncharacteristic difficulties such as nausea, sleeplessness or drowsiness, fatigue, depression or confusion. Both outpatient and inpatient treatment of exacerbation is symptomatic.
The symptoms of obstruction are treated with bronchodflators and corticosteroid, hypoxemia with oxygen therapy and signs of bacterial infection with antibiotics.