Strategy in the diagnosis and management of exacerbations of chronic obstructive pulmonary disease (COPD)
Abstract
The recommendations now in force do not include a precise definition of exacerbation - they only state that in stage I, mild degree of COPD, and in stage II, medium degree of COPD, exacerbation is accompanied by greater dyspnoea, often together with stronger coughing and greater sputum production. The treatment of such patients rarely requires hospital admission.
In patients presenting with stage III (severe) and IV (very severe) of the disease, exacerbation may bring about or deteriorate dyspnoea and such patients are,therefore, mostly treated in hospital. The chief causes of exacerbations are infections of the tracheobronchial tree and polluted environment.
During exacerbations we see bronchospasms, oedema of the bronchial mucosa and sputum stagnation. As the bronchial wall is in most instances already primarily thickened, there is a markedly higher resistance.
This is due to the dependence of resistance on the value of the radius raised to the power four. The primary symptom of exacerbation is a feeling of difficult breathing, often accompanied by wheezing, a change in sputum colour or viscosity and fever.
Exacerbations may also present as non-characteristic complaints such as nausea, insomnia or on the contrary drowsiness, tiredness, depression and confusion. Such nonspecific disorders tend to be overlooked or seen as symptoms of another disease.
The treatment of exacerbations is symptomatic. For symptoms of obstruction we administer bronchodilators and corticosteroids, for hypoxaemia we administer oxygen, while signs of bacterial infections are treated with antibiotics.