It defined as an acute decline in respiratory functions manifested as severely worsening dyspnoea, cough and sputum production from the symptoms baseline. It triggered by an infection, airborne pollutants, and/or other factors (smoking).
Please follow Explicit criteria for hospital admission in exacerbations of chronic obstructive pulmonary disease.
Worsening chronic cough +/- sputum, Hx of long life smoking, dyspnea, tachypnea, lung wheezing, lower lobe crackles, hyper-resonance, +/- lung consolidation signs.
|Spirometry||Diagnostic: FEV1/FVC ratio <0.70, post bronchodilator||High sensitivity, High specificity|
|Chest radiology||To excluded other pathology And to monitor for complications, i.e PnTX||Variable sensitive, low specificity|
|Pulse oximetry||For monitoring.||High sensitivity for blood oxygenation. Not specific for COPD|
|Blood gases||For monitoring, if indicated.||FEV1 <35%, pulse oximetry <92%,depressed level of consciousness or acute exacerbation of COPD|
|alpha-1 antitrypsin||If patient is < 45 y/o|
|Diffusing capacity for CO||For monitoring the severity of emphysema.|
Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria:
GOLD 1 - mild: FEV1≥ 80% predicted
GOLD 2 - moderate: 50% ≤ FEV1 < 80% predicted
GOLD 3 - severe: 30% ≤ FEV1 < 50% predicted
GOLD 4 - very severe: FEV1 <30% predicted.
Maximize blood oxygenation.
Reduce GOLD stage.
Reduce the risk of COPD exacerbation.
Reduce the risk of pneumonia.
Reduce the risk of cardiac complications.
FEV1 every 1 year.
How to use the levels:
Lvl 1 for:
Fewer manifestations and ≤1 exacerbation last year.
Lvl 2 for:
More manifestations and ≤1 exacerbation last year.
Fewer manifestation and ≥2 exacerbations last year.
More manifestation and ≥2 exacerbations last year.