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Diagnose und Therapie der COPD-Exazerbation

Diagnosis and therapy of COPD exacerbation

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Zusammenfassung

Die akute Exazerbation einer COPD (AECOPD) ist eine bedrohliche klinische Situation. Dieser Beitrag erläutert die Definition einer AECOPD, die Schweregradeinteilung, typische klinische Phänomene mit Hinweis auf häufige Fallstricke in der Diagnostik, Therapie und Prognose. Obligate Aspekte der speziellen Anamnese und körperlichen Untersuchung für die klinische Einschätzung vor allem bei schwergradigen Exazerbationen werden erläutert. Die notwendigen apparativen Begleituntersuchungen wie Thoraxröntgenuntersuchung, Blutgasanalyse, EKG und Echokardiographie und deren differenzialdiagnostische sowie therapeutische Signifikanz werden beschrieben. Bezüglich der wichtigsten Laboruntersuchungen wird auch zu strittigen Parametern, z. B. Procalcitonin, Stellung genommen und auf den differenzierten Bedarf der mikrobiologischen Sputumaufbereitung hingewiesen. Besonderes Gewicht wird auf die wesentlichen Säulen des therapeutischen Managements der schweren AECOPD gelegt. Praktische Aspekte der unkontrollierten Sauerstofftherapie, Substanzauswahl und Applikationsform der inhalativen Akuttherapie, Dosis und Dauer von Glukokortikoiden, der Indikation zu Antibiose, maschineller Beatmung, aber auch Opiaten werden zusammengefasst.

Abstract

The acute exacerbation of COPD (AECOPD) is a life-threatening clinical situation. This review summarizes the definition of AECOPD, the severity assessment, typical clinical signs and symptoms, and refers to clinical pitfalls of diagnosis and therapy. Important aspects of clinical history and physical examination in severe exacerbations are reported. The necessary accompanying examinations like chest X-ray, blood gas analysis, ECG and echocardiography and their differential diagnosis as well as therapeutic significance are described. The most important lab examinations are summarized and controversial parameters, e.g., procalcitonin, are commented upon. The differentiated need for a microbiological sputum screening is emphasized. The authors place special weight on the essential components of the therapeutic management of severe AECOPD. Practical aspects of uncontrolled oxygen therapy, drug selection, and application form of inhalative acute therapy, dose, and duration of glucocorticoids, the indication for antibiotics, mechanical ventilation, and also opiates are summarized.

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Authors and Affiliations

  1. Lungenklinik Heckeshorn, Klinik für Pneumologie, HELIOS-Klinikum Emil von Behring, Berlin, Deutschland

    T.T. Bauer

  2. Klinik für Pneumologie, Allergologie und Schlafmedizin, HELIOS-Klinik Hagen-Ambrock, Hagen, Deutschland

    G. Nilius

  3. Klinik für Pneumologie, HELIOS-Kliniken Schwerin, Schwerin, Deutschland

    W. Grüning

  4. Bergisches Lungenzentrum, Klinik für Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, HELIOS-Klinikum Wuppertal, Klinikum der Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland

    K. Rasche

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  1. T.T. Bauer
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  2. G. Nilius
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  3. W. Grüning
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  4. K. Rasche
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Correspondence to K. Rasche.

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Bauer, T., Nilius, G., Grüning, W. et al. Diagnose und Therapie der COPD-Exazerbation. Med Klin Intensivmed Notfmed 107, 172–178 (2012). https://doi.org/10.1007/s00063-011-0065-y

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  • DOI: https://doi.org/10.1007/s00063-011-0065-y

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