Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Primer for Emergency Physicians

Abstract

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose a significant burden on patients and the emergency health care system. Patients with COPD who present to the emergency department (ED) often have comorbidities that can complicate their management. Objective: To discuss strategies for the management of acute exacerbations in the ED, from initial assessment through disposition, to enable effective patient care and minimize the risk of treatment failure and prevent hospital readmissions. Discussion: Establishing a correct diagnosis early on is critical; therefore, initial evaluations should be aimed at differentiating COPD exacerbations from other life-threatening conditions. Disposition decisions are based on the intensity of symptoms, presence of comorbidities, severity of the disease, and response to therapy. Patients who are appropriate for discharge from the ED should be prescribed evidence-based treatments and smoking cessation to prevent disease progression. A patient-centric discharge care plan should include medication reconciliation; bedside ''teach-back,'' wherein patients demonstrate proper inhaler usage; and prompt follow-up. Conclusions: An effective assessment, accurate diagnosis, and appropriate discharge plan for patients with AECOPD could improve treatment outcomes, reduce hospitalization, and decrease unplanned repeat visits to the ED.

Procalcitonin kinetics to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: procalcitonin’s adjunct role

“…Depending on the different extents of using assisted respiratory support measures, there are two treatment methods in clinical practice: one is invasive respirator-assisted ventilation, and the other noninvasive respirator-assisted ventilation [28,29]. Indwelling endotracheal intubation for mechanical ventilation can effectively dilate the airway of spastic obstruction, reduce carbon dioxide retention, improve the state of ventilation and oxygenation, and promote the rapid improvement of the patients' conditions [30]. Although invasive mechanical ventilation is the primary approach of treatment for the patients with ARF in a state of unconsciousness, it does not work well to the patients with COPD because the functions of their airway structural defense barrier would be attenuated with a higher risk of bacterial infection due to the existence of irreversible airway obstruction lesions, reduction of mucosal surface cilia, mucosal hyperemia and edema, and mucous glandular cell hyperplasia and hypertrophy [31,32].…”

A Case of Apnea in COPD Patients Induced by Sedatives

“…The patient was transferred to the intensive care unit after difficult ward management. Point of care ultrasound has been widely used in perioperative nerve block anaesthesia, and bedside ultrasound based on severe cases has played an important role during COVID-19 [6][7][8][9]. Perioperative evaluation bedside ultrasound practice is also increasing in anaesthesia [10][11][12].…”

Statins Associated with Better Long-Term Outcomes in Aged Hospitalized Patients with COPD: A Real-World Experience from Pay-for-Performance Program

“…Chronic obstructive pulmonary disease (COPD), the third leading cause of death globally, is a chronic inflammatory disease of the lower respiratory tract that causes progressive and damaging airflow obstruction [1][2][3][4]. The estimated global prevalence of COPD was approximately 11.7% in 2010 [5], and the mortality of COPD is projected to increase to more than 5.4 million annually by 2060 due to the aging populations increased in our society [6,7]. As COPD progresses, aged patients are usually accompanied by multiple comorbidities and frequently experience an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) that results in lung function deterioration and mortality [8].…”