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Chronic obstructive pulmonary disease - Management
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How do I diagnose an acute exacerbation of COPD?

  • An acute exacerbation of COPD is a sustained worsening of a person's symptoms from their usual stable state, which is beyond normal day-to-day variations and acute in onset. There is no single defining symptom of an exacerbation.
  • Commonly reported symptoms are:
    • Increased breathlessness.
    • Increased cough.
    • Increased sputum production and change in sputum colour.
  • Other symptoms may include:
    • Increased wheeze and chest tightness.
    • Upper respiratory tract symptoms (for example colds or sore throats).
    • Reduced exercise tolerance.
    • Fluid retention.
    • Increased fatigue.
    • Acute confusion.

Basis for recommendation

This information is based on expert opinion in the National Institute for Health and Clinical Excellence (NICE) clinical guideline, Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update) [National Clinical Guideline Centre, 2010; NICE, 2010].

  • The definition of an acute exacerbation is from NICE. However, NICE asserts that there is no agreed uniform definition.
  • The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines an exacerbation of COPD as 'an event in the natural course of the disease characterized by a change in the patient's baseline dyspnoea, cough, and/or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in regular medication' [GOLD, 2009].

What else might it be?

  • Conditions which present with symptoms similar to those of an acute exacerbation of chronic obstructive pulmonary disease include:
    • Pneumonia.
    • Pneumothorax.
    • Left ventricular failure/pulmonary oedema.
    • Pulmonary embolism.
    • Lung cancer.
    • Upper airway obstruction.
    • Pleural effusion.
    • Recurrent aspiration.

Basis for recommendation

This information is based on expert opinion in the National Institute for Health and Clinical Excellence (NICE) clinical guideline Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update) [National Clinical Guideline Centre, 2010; NICE, 2010].

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