Acute exacerbation of chronic obstructive pulmonary disease

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Acute exacerbation of chronic obstructive pulmonary disease
Other namesAcute exacerbations of chronic bronchitis (AECB)
X-ray of COPD exacerbation - anteroposterior view.jpg
Chest X-ray in a case of COPD exacerbation where a nasopharyngeal swab detected Haemophilus influenzae , with right-sided opacities
Specialty Respirology, emergency medicine

An acute exacerbation of chronic obstructive pulmonary disease, or acute exacerbations of chronic bronchitis (AECB), is a sudden worsening of chronic obstructive pulmonary disease (COPD) symptoms including shortness of breath, quantity and color of phlegm that typically lasts for several days.

Contents

It may be triggered by an infection with bacteria or viruses or by environmental pollutants. Typically, infections cause 75% or more of the exacerbations; bacteria can roughly be found in 25% of cases, viruses in another 25%, and both viruses and bacteria in another 25%. Airway inflammation is increased during the exacerbation resulting in increased hyperinflation, reduced expiratory air flow and decreased gas exchange. [1] [2]

Exacerbations can be classified as mild, moderate, and severe. [3] As COPD progresses, exacerbations tend to become more frequent, the average being about three episodes per year. [4]

Signs and symptoms

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. [ citation needed ] 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]

Causes

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:

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

Diagnosis

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.[ citation needed ]

Prevention

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:

Treatment

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]

Oxygen

Oxygen therapy should be initiated if there is significantly low blood oxygen. High flow oxygen may be harmful in those with an acute exacerbation of COPD. In the prehospital environment those given high flow O2 rather than titrating their O2 saturations to 88% to 92% had worse outcomes. [14] In specific circumstances high flow oxygen however can be beneficial. [15] Antibiotics and steroids appear useful in mild to severe disease. [16]

Medications

There should also be a "care plan" in case of future exacerbations. Patients may watch for symptoms, such as shortness of breath, change in character or amount of mucus, and start self-treatment as discussed with a health care provider. This allows for treatment right away until a doctor can be seen. [5]

The symptoms of acute exacerbations are treated using short-acting bronchodilators. A course of corticosteroids, usually in tablet or intravenous rather than inhaled form, can speed up recovery. [1] The IV and oral forms of steroids have been found to be equivalent. [20] Antibiotics are often used but will only help if the exacerbation is due to an infection. [21] Antibiotics are indicated when a patient notes increased sputum production, [6] purulent sputum, [6] increased dyspnea, [6] has an elevated white count, or is febrile. Examples of first-line antibiotics are amoxicillin, [6] doxycycline, [6] and co-trimoxazole. [6]

Mechanical ventilation

Severe exacerbations can require hospital care where treatments such as oxygen and mechanical ventilation may be required. [22] Mechanical ventilation can be invasive (endotracheal intubation) or non-invasive forms of ventilation such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP).[ citation needed ]

Epidemiology

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.

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<span class="mw-page-title-main">Asthma</span> Long-term inflammatory disease of the airways of the lungs

Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These may occur a few times a day or a few times per week. Depending on the person, asthma symptoms may become worse at night or with exercise.

<span class="mw-page-title-main">Pneumonia</span> Inflammation of the alveoli of the lungs

Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable.

<span class="mw-page-title-main">Respiratory failure</span> Inadequate gas exchange by the respiratory system

Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise in arterial carbon dioxide levels is called hypercapnia. Respiratory failure is classified as either Type 1 or Type 2, based on whether there is a high carbon dioxide level, and can be acute or chronic. In clinical trials, the definition of respiratory failure usually includes increased respiratory rate, abnormal blood gases, and evidence of increased work of breathing. Respiratory failure causes an altered mental status due to ischemia in the brain.

<span class="mw-page-title-main">Cough</span> Sudden expulsion of air from the lungs as a reflex to clear irritants

A cough is a sudden expulsion of air through the large breathing passages which can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound.

<span class="mw-page-title-main">Shortness of breath</span> Feeling of difficulty breathing

Shortness of breath (SOB), also medically known as dyspnea or dyspnoea, is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity", and recommends evaluating dyspnea by assessing the intensity of its distinct sensations, the degree of distress and discomfort involved, and its burden or impact on the patient's activities of daily living. Distinct sensations include effort/work to breathe, chest tightness or pain, and "air hunger". The tripod position is often assumed to be a sign.

<span class="mw-page-title-main">Sputum</span> Mucus that is coughed up from the lower airways

Sputum is mucus that is coughed up from the lower airways. In medicine, sputum samples are usually used for a naked eye examination, microbiological investigation of respiratory infections and cytological investigations of respiratory systems. It is crucial that the specimen does not include any mucoid material from the nose or oral cavity.

<span class="mw-page-title-main">Acute bronchitis</span> Medical condition

Acute bronchitis, also known as a chest cold, is short-term bronchitis – inflammation of the bronchi of the lungs. The most common symptom is a cough. Other symptoms include coughing up mucus, wheezing, shortness of breath, fever, and chest discomfort. The infection may last from a few to ten days. The cough may persist for several weeks afterward with the total duration of symptoms usually around three weeks. Some have symptoms for up to six weeks.

<span class="mw-page-title-main">Bronchiectasis</span> Disease of the lungs

Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. Symptoms typically include a chronic cough with mucus production. Other symptoms include shortness of breath, coughing up blood, and chest pain. Wheezing and nail clubbing may also occur. Those with the disease often get lung infections.

<i>Haemophilus influenzae</i> Species of bacterium

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<span class="mw-page-title-main">Lower respiratory tract infection</span> Medical term

Lower respiratory tract infection (LRTI) is a term often used as a synonym for pneumonia but can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue. A routine chest X-ray is not always necessary for people who have symptoms of a lower respiratory tract infection.

<span class="mw-page-title-main">Bronchoconstriction</span> Constriction of the terminal airways in the lungs

Bronchoconstriction is the constriction of the airways in the lungs due to the tightening of surrounding smooth muscle, with consequent coughing, wheezing, and shortness of breath.

<span class="mw-page-title-main">Pneumonitis</span> General inflammation of lung tissue

Pneumonitis describes general inflammation of lung tissue. Possible causative agents include radiation therapy of the chest, exposure to medications used during chemo-therapy, the inhalation of debris, aspiration, herbicides or fluorocarbons and some systemic diseases. If unresolved, continued inflammation can result in irreparable damage such as pulmonary fibrosis.

Community-acquired pneumonia (CAP) refers to pneumonia contracted by a person outside of the healthcare system. In contrast, hospital-acquired pneumonia (HAP) is seen in patients who have recently visited a hospital or who live in long-term care facilities. CAP is common, affecting people of all ages, and its symptoms occur as a result of oxygen-absorbing areas of the lung (alveoli) filling with fluid. This inhibits lung function, causing dyspnea, fever, chest pains and cough.

<span class="mw-page-title-main">Respiratory disease</span> Disease of the respiratory system

Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, influenza, and pharyngitis to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, tuberculosis, acute asthma, lung cancer, and severe acute respiratory syndromes, such as COVID-19. Respiratory diseases can be classified in many different ways, including by the organ or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause of the disease.

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Bronchitis is inflammation of the bronchi in the lungs that causes coughing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi. Symptoms include coughing up sputum, wheezing, shortness of breath, and chest pain. Bronchitis can be acute or chronic.

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Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. In general, pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient. Pulmonary rehabilitation may be carried out in a variety of settings, depending on the patient's needs, and may or may not include pharmacologic intervention.

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<span class="mw-page-title-main">Chronic obstructive pulmonary disease</span> Lung disease involving long-term poor airflow

Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms of COPD include shortness of breath and a cough, which may or may not produce mucus. COPD progressively worsens, with everyday activities such as walking or dressing becoming difficult. While COPD is incurable, it is preventable and treatable. The two most common types of COPD are emphysema and chronic bronchitis and have been the two classic COPD phenotypes. Emphysema is defined as enlarged airspaces (alveoli) whose walls have broken down resulting in permanent damage to the lung tissue. Chronic bronchitis is defined as a productive cough that is present for at least three months each year for two years. Both of these conditions can exist without airflow limitation when they are not classed as COPD. Emphysema is just one of the structural abnormalities that can limit airflow and can exist without airflow limitation in a significant number of people. Chronic bronchitis does not always result in airflow limitation but in young adults who smoke the risk of developing COPD is high. Many definitions of COPD in the past included emphysema and chronic bronchitis, but these have never been included in GOLD report definitions. Emphysema and chronic bronchitis remain the predominant phenotypes of COPD but there is often overlap between them and a number of other phenotypes have also been described. COPD and asthma may coexist and converge in some individuals. COPD is associated with low-grade systemic inflammation.

References

  1. 1 2 Rabe KF, Hurd S, Anzueto A, et al. (2007). "Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary". Am. J. Respir. Crit. Care Med. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. hdl: 2066/51740 . PMID   17507545. S2CID   20863981.
  2. ↑ van Geffen WH, Slebos DJ, Kerstjens HA (2015). "Hyperinflation in COPD exacerbations". The Lancet Respiratory Medicine. 3 (12): 43–44. doi: 10.1016/S2213-2600(15)00459-2 . PMID   26679031.
  3. 1 2 3 "2 Diagnosis and Initial Assessment § Assessment of exacerbation risk". Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (PDF). Global Initiative for Chronic Obstructive Lung Disease. 2019. pp. 32–33. Retrieved 22 September 2019.
  4. 1 2 "Chronic Obstructive Pulmonary Disease (COPD)". Merck Sharp & Dohme Corp. Retrieved 19 May 2014.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 "Acute Exacerbations of Chronic Bronchitis (AECB)". MedBroadcast.
  6. 1 2 3 4 5 6 7 Uppsala Academic Hospital > Guidelines for treatment of acute lung diseases. August 2004. Authors: Christer Hanson, Carl-Axel Karlsson, Mary Kämpe, Kristina Lamberg, Eva Lindberg, Lavinia Machado Boman, Gunnemar Stålenheim
  7. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 "Acute exacerbations of chronic bronchitis (AECB)". The British Society for Antimicrobial Chemotherapy. Archived from the original on 2006-04-06.
  8. ↑ Geffen, Wouter H. van; Bruins, Marcel; Kerstjens, Huib A. M. (2016-01-01). "Diagnosing viral and bacterial respiratory infections in acute COPD exacerbations by an electronic nose: a pilot study". Journal of Breath Research. 10 (3): 036001. Bibcode:2016JBR....10c6001V. doi: 10.1088/1752-7155/10/3/036001 . ISSN   1752-7163. PMID   27310311.
  9. ↑ Makris D, Bouros D (January 2009). "COPD Exacerbtion: Lost in Translation". BMC Pulm Med. 9 (6): 6. doi:10.1186/1471-2466-9-6. PMC   2640343 . PMID   19178701.
  10. ↑ Calverley PM, Anderson JA, Celli B, et al. (2007). "Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease". N. Engl. J. Med. 356 (8): 775–89. doi: 10.1056/NEJMoa063070 . PMID   17314337.
  11. ↑ Tashkin DP, Celli B, Senn S, et al. (October 2008). "A 4-year trial of tiotropium in chronic obstructive pulmonary disease". The New England Journal of Medicine. 359 (15): 1543–54. doi:10.1056/NEJMoa0805800. hdl: 2437/111564 . PMID   18836213.
  12. ↑ Zhou Y, Wang X, Zeng X, et al. (2006). "Positive benefits of theophylline in a randomized, double-blind, parallel-group, placebo-controlled study of low-dose, slow-release theophylline in the treatment of COPD for 1 year". Respirology. 11 (5): 603–10. doi:10.1111/j.1440-1843.2006.00897.x. PMID   16916334. S2CID   28582690.
  13. ↑ Burge PS, Calverley PM, Jones PW, Spencer S, Anderson JA, Maslen TK (2000). "Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial". BMJ. 320 (7245): 1297–303. doi:10.1136/bmj.320.7245.1297. PMC   27372 . PMID   10807619.
  14. ↑ Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R (2010). "Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial". BMJ. 341: c5462. doi:10.1136/bmj.c5462. PMC   2957540 . PMID   20959284.
  15. ↑ Veenstra, Pieter; Veeger, Nic J. G. M.; Koppers, Ralph J. H.; Duiverman, Marieke L.; Geffen, Wouter H. van (2022-10-05). "High-flow nasal cannula oxygen therapy for admitted COPD-patients. A retrospective cohort study". PLOS ONE. 17 (10): e0272372. doi:10.1371/journal.pone.0272372. ISSN   1932-6203. PMC   9534431 . PMID   36197917.
  16. ↑ Dobler, CC; Morrow, AS; Beuschel, B; Farah, MH; Majzoub, AM; Wilson, ME; Hasan, B; Seisa, MO; Daraz, L; Prokop, LJ; Murad, MH; Wang, Z (17 March 2020). "Pharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-analysis". Annals of Internal Medicine. 172 (6): 413–422. doi:10.7326/M19-3007. PMID   32092762. S2CID   211476101.
  17. 1 2 Bach PB, Brown C, Gelfand SE, McCrory DC (2001). "Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence". Ann. Intern. Med. 134 (7): 600–20. doi:10.7326/0003-4819-134-7-200104030-00016. PMID   11281745. S2CID   35537845.
  18. ↑ van Geffen WH, Douma WR, Slebos DJ, Kerstjens HA (August 2016). "Bronchodilators delivered by nebuliser versus pMDI with spacer or DPI for exacerbations of COPD". The Cochrane Database of Systematic Reviews. 2016 (8): CD011826. doi:10.1002/14651858.CD011826.pub2. PMC   8487315 . PMID   27569680.
  19. ↑ Walters, Julia Ae; Tan, Daniel J.; White, Clinton J.; Wood-Baker, Richard (19 March 2018). "Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease". The Cochrane Database of Systematic Reviews. 2018 (3): CD006897. doi:10.1002/14651858.CD006897.pub4. ISSN   1469-493X. PMC   6494402 . PMID   29553157.
  20. ↑ Lindenauer PK, Pekow PS, Lahti MC, Lee Y, Benjamin EM, Rothberg MB (June 2010). "Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease". JAMA. 303 (23): 2359–67. doi: 10.1001/jama.2010.796 . PMID   20551406.
  21. ↑ Gibson, et al. Evidence-based Respiratory Medicine. Blackwell Publishing, 2005. ISBN   0-7279-1605-X. pp. 390–392.
  22. ↑ Quon BS, Gan WQ, Sin DD (March 2008). "Contemporary management of acute exacerbations of COPD: a systematic review and metaanalysis". Chest. 133 (3): 756–66. CiteSeerX   10.1.1.619.4554 . doi:10.1378/chest.07-1207. PMID   18321904.
  23. ↑ Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA (February 1987). "Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease". Ann. Intern. Med. 106 (2): 196–204. doi:10.7326/0003-4819-106-2-196. PMID   3492164.
  24. ↑ Page 249 in: Balter MS, La Forge J, Low DE, Mandell L, Grossman RF (2003). "Canadian guidelines for the management of acute exacerbations of chronic bronchitis". Can. Respir. J. 10 Suppl B: 3B–32B. doi: 10.1155/2003/486285 . PMID   12944998.
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  25. ↑ "MORBIDITY & MORTALITY: 2009 CHART BOOK ON CARDIOVASCULAR, LUNG, AND BLOOD DISEASES" (PDF). National Heart, Lung, and Blood Institute. Archived from the original (PDF) on October 19, 2013.
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