Abstract
A COPD exacerbation is defined as an increase in the symptoms of COPD (dyspnea, cough, sputum production, and sputum purulence) of a magnitude greater than the normal day-to-day variability.1,2 An increase in airway inflammation is considered central to the pathogenesis of a COPD exacerbation. A stimulus that acutely increases airway inflammation results in increased bronchial tone, increased bronchial wall edema, and increased mucus production. These processes worsen ventilation–perfusion mismatch and expiratory flow limitation. Corresponding clinical manifestations include worsening gas exchange, dyspnea, cough, sputum production, and sputum purulence, which are the cardinal manifestations of an exacerbation.
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Celli BR, MacNee W, ERS TF, et al. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Resp J. 2004;23:932–946.
Sethi S. New developments in the pathogenesis of acute exacerbations of chronic obstructive pulmonary disease. Curr Opin Infect Dis. 2004;17:113–119.
Afessa B, Morales IJ, Scanlon PD, et al. Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. Crit Care Med. 2002;30:1610–1615.
Ai-Ping C, Lee KH, Lim TK. In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: a retrospective study. Chest. 2005;128:518–524.
Papi A, Bellettato CM, Braccioni F, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med. 2006;173:1114–1121.
Nseir S, Di PC, Cavestri B, et al. Multiple-drug-resistant bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease: prevalence, risk factors, and outcome. Crit Care Med. 2006;34:2959–2966.
Soler N, Torres A, Ewig S, et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med 1998;157:1498–1505.
Ferrer M, Ioanas M, Arancibia F, et al. Microbial airway colonization is associated with noninvasive ventilation failure in exacerbation of chronic obstructive pulmonary disease. Crit Care Med. 2005;33:2003–2009.
Rizkallah J, Man P, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD. A systematic review and metaanalysis. Chest. 2009;135:786–793.
Sohne M, Kruip MJ, Nijkeuter M, et al. Accuracy of clinical decision rule, D-dimer and spiral computed tomography in patients with malignancy, previous venous thromboembolism, COPD or heart failure and in older patients with suspected pulmonary embolism. J Throm Haemo. 2006;4:1042–1046.
Quon BS, Gan WQ, Sin DD. Contemporary management of acute exacerbations of COPD: a systematic review and metaanalysis. Chest. 2008;133:756–766.
Walters JA, Gibson PG, Wood-Baker R, et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2009;1:CD001288.
Ward NS, Dushay KM. Clinical concise review: mechanical ventilation of patients with chronic obstructive pulmonary disease. Crit Care Med. 2008;36:1614–1619.
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Marik, P.E. (2010). COPD Exacerbation. In: Handbook of Evidence-Based Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5923-2_22
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DOI: https://doi.org/10.1007/978-1-4419-5923-2_22
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