COPD-X | X3. Refer appropriately to prevent further deterioration (‘P’)

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X: Manage eXacerbations

X3. Refer appropriately to prevent further deterioration (‘P’)

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X3. Refer appropriately to prevent further deterioration (‘P’)

The risk of death from exacerbations of COPD increases with acute carbon dioxide retention (respiratory acidosis), the presence of significant comorbid conditions (eg, ischaemic heart disease) and complications (eg, pneumonia and empyema). Depending on the nature and severity of the exacerbation, the patient may require urgent specialist review, hospital assessment or admission to a high-dependency or intensive care facility for ventilatory support and appropriate monitoring (see Box 10 and Box 11).

Box 10: Indications for hospitalisation of patients with chronic obstructive pulmonary disease

Marked increase in intensity of symptoms

Patient has acute exacerbation characterised by increased dyspnoea, cough or sputum production, plus one or more of the following:

Inadequate response to ambulatory management
Inability to walk between rooms when previously mobile
Inability to eat or sleep because of dyspnoea
Cannot manage at home even with home-care resources
High risk comorbidity condition - pulmonary (eg, pneumonia) or non-pulmonary
Altered mental status suggestive of hypercapnia
Worsening hypoxaemia or cor pulmonale
Newly occurring arrhythmia

Box 11: Indications for non-invasive or invasive ventilation

Severe dyspnoea that responds inadequately to initial emergency therapy
Confusion, lethargy or evidence of hypoventilation
Persistent or worsening hypoxaemia despite supplemental oxygen, worsening hypercapnia (Paco2 > 70 mmHg), or severe or worsening respiratory acidosis (blood pH < 7.3)
Assisted mechanical ventilation is required.

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COPD-X Plan - Version 2.26 - August 2011

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Top COPD-X Areas

C: Confirm diagnosis

O: Optimise function

X: Manage eXacerbations

P: Prevent deterioration

O1. Inhaled bronchodilators

D: Develop support network and self-management

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