Acute exacerbations of COPD

Acute exacerbations of COPD
Common medical emergency especially in winter. May be triggered by viral or bacterial infections.

Presentation
Increasing cough, breathlessness, or wheeze. Decreased exercise capacity.

History
Ask about usual/recent treatments (especially home oxygen), smoking status, and exercise capacity (may influence a decision to ventilate the patient).

Differential diagnosis
Asthma, pulmonary oedema, upper respiratory tract obstruction, pulmonary embolus, anaphylaxis.

Investigations
Peak expiratory flow (PEF)—but may be too ill.
Arterial blood gases.
CXR to exclude pneumothorax and infection.
FBC; U&E; CRP.
ECG.
Blood cultures (if pyrexial).
Send sputum for culture.