May represent the first presentation of COPD, usually associated with a history of tobacco exposure.
Typically presents with an increased level of dyspnea, worsening of chronic cough, and/or an increase in the volume and/or purulence of the sputum produced.
Treatment includes bronchodilators, systemic corticosteroids, and antibiotics.
Antibiotics may be reserved for exacerbations thought to be due to bacteria. An acute change in the volume and color of sputum produced is suggestive of a bacterial trigger.
Treatment may be complicated by the development of hyperglycemia (associated with the use of corticosteroids) and/or diarrhea, including Clostridium difficile-associated diarrhea (associated with the use of antibiotics).
- changes in sputum volume/color/thickness
- past medical hx COPD
- tobacco use
- past medical hx of gastroesophageal reflux/swallowing dysfunction
- environmental/occupational exposure to pollutants or dust
- malaise and fatigue
- chest tightness
- features of cor pulmonale
- change in mental status
- accessory muscle use
- paradoxical movements of abdomen
1st Tests To Order
- SaO2 on pulse oximetry
- chest radiograph
- CBC with platelets
- electrolytes, BUN, + creatinine
Other Tests to Consider
- sputum culture + Gram stain
- respiratory virus diagnostics
- cardiac troponin
- CT scan of chest
- short-acting bronchodilators
- systemic glucocorticoids
- airway clearance techniques
- suspected bacterial etiology (exacerbation of lesser severity)
- narrow-spectrum antibiotics
- suspected bacterial etiology (exacerbation of greater severity)
- broad-spectrum antibiotics
- severe exacerbations
- noninvasive positive-pressure ventilation
- invasive positive-pressure ventilation
- pulmonary rehabilitation and disease-management programs