Sandbox/22

Management

COPD Exacerbation ❑ Cough ↑ ❑ Dyspnea ↑ ❑ Sputum ↑

Oxygen Supplement ❑ Pulse oximetry (maintain SaO2 ≥88—92%) ❑ Arterial blood gas (if acute or acute-on-chronic respiratory failure is suspected)† Indications for ICU Admission ❑ Hemodynamic instability ❑ Changes in mental status (confusion, lethargy, coma) ❑ Severe dyspnea that responds inadequately to initial emergency therapy ❑ Worsening hypoxemia (PaO2 <40 mm Hg) and/or respiratory acidosis (pH <7.25) Indications for Hospitalization ❑ Marked increase in intensity of symptoms (eg, sudden development of resting dyspnea) ❑ Severe underlying COPD (GOLD 3—4 categories) ❑ Onset of new physical signs (eg, cyanosis, peripheral edema) ❑ Failure of an exacerbation to respond to initial medical management ❑ Presence of serious comorbidities (eg, heart failure or newly occurring arrhythmias) ❑ Frequent exacerbations (≥2 events per year) ❑ Older age (>65 years) ❑ Insufficient home support

Assessment of Exacerbation ❑ Chest radiograph (exclude alternative diagnoses) ❑ ECG (check coexisting cardiac problems) ❑ Whole-blood count (identify polycythemia, anemia, or leukocytosis) ❑ Electrolytes and glucose (identify electrolyte disturbances or hyperglycemia)

Severity of Exacerbation ❑ Mild (require change of inhaled treatment by the patient) ❑ Moderate (require medical intervention including a short course of ABx or oral steroids) ❑ Severe (require hospitalization)

^†Pa_O2 <60 mm Hg with or without Pa_CO2 >50 mm Hg in ambient air