Acute exacerbation of chronic obstructive pulmonary disease

An acute exacerbation of COPD is associated with increased frequency and severity of coughing.[5] It is often accompanied by worsened chest congestion and discomfort. Shortness of breath and wheezing are present in many cases.[5] Exacerbations may be accompanied by increased amount of cough and sputum productions, and a change in appearance of sputum. An abrupt worsening in COPD symptoms may cause rupture of the airways in the lungs, which in turn may cause a spontaneous pneumothorax.[4]

In infection, there is often weakness, fever and chills. If due to a bacterial infection, the sputum may be slightly streaked with blood and coloured yellow or green.[5]

As the lungs tend to be vulnerable organs due to their exposure to harmful particles in the air, several things can cause an acute exacerbation of COPD:

• Respiratory infection, being responsible for approximately half of COPD exacerbations. Approximately half of these are due to viral infections and another half appears to be caused by bacterial infections.[6] Common bacterial pathogens of acute exacerbations include Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis.[7] Less common bacterial pathogens include Chlamydia pneumoniae and MRSA.[7] Pathogens seen more frequently in patients with impaired lung function (FEV<35% of predicted) include Haemophilus parainfluenzae (after repeated use of antibiotics), Mycoplasma pneumoniae and gram-negative, opportunistic pathogens like Pseudomonas aeruginosa and Klebsiella pneumoniae.[7]
• Allergens, e.g., pollens, wood or cigarette smoke, pollution[5]
• Toxins, including a variety of different chemicals[5]
• Air pollution
• Failing to follow a drug therapy program, e.g. improper use of an inhaler

In one-third of all COPD exacerbation cases, the cause cannot be identified.

The diagnostic criteria for acute exacerbation of COPD generally include a production of sputum that is purulent[7] and may be thicker[5] than usual, but without evidence of pneumonia (which involves mainly the alveoli rather than the bronchi).[5] Also, diagnostic criteria may include an increase in frequency and severity of coughing,[5] as well as increased shortness of breath.[7]

A chest X-ray is usually performed on people with fever and, especially, hemoptysis (blood in the sputum), to rule out pneumonia and get information on the severity of the exacerbation. Hemoptysis may also indicate other, potentially fatal, medical conditions.[5]

A history of exposure to potential causes and evaluation of symptoms may help in revealing the cause the exacerbation, which helps in choosing the best treatment. A sputum culture can specify which strain is causing a bacterial AECB.[5] An early morning sample is preferred.[7]

E-nose showed the ability to smell the cause of the exacerbation.[8]

The definition of a COPD exacerbation is commonly described as "lost in translation",[9] meaning that there is no universally accepted standard with regard to defining an acute exacerbation of COPD. Many organizations consider it a priority to create such a standard, as it would be a major step forward in the diagnosis and quality of treatment of COPD.

Acute exacerbations can be partially prevented. Some infections can be prevented by vaccination against pathogens such as influenza and Streptococcus pneumoniae. Regular medication use can prevent some COPD exacerbations; long acting beta-adrenoceptor agonists (LABAs), long-acting anticholinergics, inhaled corticosteroids and low-dose theophylline have all been shown to reduce the frequency of COPD exacerbations.[10][11][12][13] Other methods of prevention include:

• Smoking cessation and avoiding dust, passive smoking, and other inhaled irritants[5]
• Yearly influenza and 5-year pneumococcal vaccinations[5]
• Regular exercise, appropriate rest, and healthy nutrition[5]
• Avoiding people currently infected with e.g. cold and influenza[5]
• Maintaining good fluid intake and humidifying the home, in order to help reduce the formation of thick sputum and chest congestion.[5]

Based on the severity different treatments may be used.[3] Mild exacerbations are treated with short acting bronchodilators (SABDs). Moderate exacerbations are treated with SABDs together with antibiotics or oral corticosteroids, or both. Severe exacerbations need hospital treatment, and the prognosis is poor.[3]

The incidence varies depending on which definition is used, but definitions by Anthonisen et al.[23] the typical COPD patient averages two to three AECB episodes per year.[24] With a COPD prevalence of more than 12 million (possibly 24 million including undiagnosed ones) in the United States,[25] there are at least 30 million incidences of AECB annually in the US.