Pharmacy & Acute Care University
Pharmacy & Acute Care University
Lesson 1, Topic 1
In Progress

Summary and References

COPD exacerbations are acute worsening of respiratory symptoms like dyspnea, cough, and sputum production beyond day-to-day variations. They are mainly triggered by respiratory infections, most commonly bacteria, which increase airway inflammation. Diagnosis is based on clinical symptoms and signs and may include PFTs showing worsened obstruction. Initial management includes increased bronchodilators (short-acting beta-2 agonists with or without anticholinergics), oral corticosteroids, and antibiotics for bacterial infections. Use of systemic corticosteroids, antibiotics, oxygen, and hospitalization should be guided by exacerbation severity. Key takeaways are recognizing exacerbation symptoms promptly, determining likely triggers, tailoring drug therapy to severity, and monitoring response. Preventing future exacerbations through smoking cessation, vaccinations, and optimal maintenance therapy is also essential.

  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of COPD. 2022 Report. https://goldcopd.org/2022-gold-reports-2/. Accessed January 31, 2023.
  2. Wedzicha JA, Miravitlles M, Hurst JR, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017;49(3):1600791.
  3. Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest. 2015;147(4):894-942.
  4. Walters JAE, Tan DJ, White CJ, Gibson PG, Wood-Baker R, Walters EH. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2018;9(9):CD001288.
  5. Vollenweider DJ, Jarrett H, Steurer-Stey CA, Garcia-Aymerich J, Puhan MA. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2018;12(12):CD010257.
  6. Lindenauer PK, Stefan MS, Shieh MS, et al. Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease. JAMA Intern Med. 2014;174(12):1982-1993.
  7. Puhan MA, Gimeno-Santos E, Cates CJ, Troosters T. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2016;12(12):CD005305.
  8. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Pocket Guide to COPD Diagnosis, Management, and Prevention. 2022 Report. https://goldcopd.org/gold-reports/. Accessed January 31, 2023.
  9. Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet. 2007;370(9589):786-796.
  10. Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363(12):1128-1138.
  11. Oshagbemi OA, Keene SJ, Driessen JHM, et al. Trends in moderate and severe exacerbations among COPD patients in the UK from 2005 to 2013. Respir Med. 2018;144:1-5.
  12. Donaldson GC, Hurst JR, Smith CJ, Hubbard RB, Wedzicha JA. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest. 2010;137(5):1091-1097.