COPD Exacerbation
Summary
Acute exacerbation of COPD (AECOPD) is worsening of respiratory symptoms beyond normal day-to-day variation requiring a change in therapy. Anthonisen criteria (increased dyspnoea, sputum volume, sputum purulence) guide severity. Management includes increased bronchodilators, systemic corticosteroids, antibiotics if purulent sputum, and controlled oxygen targeting 88-92% to avoid hypercapnic respiratory failure. NIV is indicated for acidotic patients.
Key Facts
- Definition: Acute worsening of respiratory symptoms in COPD
- Pathognomonic: Increased dyspnoea + sputum + purulence
- Gold Standard Investigation: ABG, CXR
- First-line Treatment: Bronchodilators + steroids +/- antibiotics
- Prognosis: In-hospital mortality 10%; 1-year mortality 25%
| Type | Symptoms |
|---|---|
| Type 1 (severe) | All 3: dyspnoea + sputum volume + purulence |
| Type 2 (moderate) | 2 of 3 |
| Type 3 (mild) | 1 of 3 + infection |
Algorithm
Treatment
| Intervention | Details |
|---|---|
| Bronchodilators | Salbutamol + ipratropium nebs |
| Steroids | Prednisolone 30mg x5 days |
| Antibiotics | Doxycycline/amoxicillin if purulent |
| Oxygen | Target 88-92% |
| NIV | If pH less than 7.35 after initial therapy |
-
GOLD. Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2024.
-
NICE guideline NG115. Chronic obstructive pulmonary disease. 2019.
Viva Points
"AECOPD: Anthonisen Type 1-3. Bronchodilators, pred 30mg x5d, antibiotics if purulent. Oxygen 88-92%. NIV if acidotic. GOLD guidelines."
Last Reviewed: 2026-01-01 | MedVellum Editorial Team