4- ACUTE COPD EXACERBATION

• Acute COPD exacerbation

  • Increased breathlessness, cough, acute bronchospasm
  • Increased sputum volume/purulence
  • Major complication is respiratory failure (type 1 or 2)
• Causes of exacerbation

  • Viral or bacterial (Strept. pneumo, H. influenza, Moraxella catarrhalis) infection (pneumonia)
  • Heart failure
  • Pulmonary embolism
  • New onset A.Fib
• Treatment

  1. Controlled Oxygen Therapy

  2. Inhalers: salbutamol + ipratropium bromide

  3. Steroids: prednisolone or IV methylprednisolone (must be given in acute phase)

  4. Antibiotics ex: co-amoxiclav (most acute exacerbations are due to infection)

  5. Cough up secretion, physiotherapy

  6. LMWH for DVT prophylaxis
• Controlled Oxygen Therapy

  • Aim: maintain saturation 88-92% & PaO2 > 8 WITHOUT increasing in CO2 (COPD pts depend on hypoxemia to maintain respiratory drive)
  • Use venturi mask to deliver fixed O2 concentration mask, start with low concentration (24%) and may be increased incrementally if there is no increase in PaCO2 or decrease in PH
  • BIPAP needed if: Signs of worsening resp. distress & acidosis, Failed to respond to optimal medical therapy & controlled oxygen, RR >30 or PH <7.35 or PaCO2 >6
  • If still no improvement with BiPAP→intubation
• Home oxygen is needed on discharge if: 6-min walk test on discharge reveals PaO2 <55 or SpO2 <88%, PaO2 <60% or SpO2 < 89-90% in pts with cor pulmonale or hematocrit >55