COPD Exacerbation

HISTORY:

‍Shortness of breathCoughIncrease in sputum volumeChange in sputum color for ‍ ‍hoursdays

‍shortness of breath

‍cough, ‍non-productiveproductive

‍sputum, ‍clearcolored

‍increase in sputum volume

‍change in sputum color

‍chest tightness

‍wheezing

‍decreased exercise tolerance

‍fatigue

‍fever, up to ‍°, over ‍ ‍hoursdays

‍orthopnea

‍paroxysmal nocturnal dyspnea

‍leg swelling, ‍rightleftsymmetrical

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Nose: ‍normal

Throat: ‍normalrednessexudate

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍COPD exacerbation ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Chest X-ray

- Blood work: ‍CBC, ‍CRP, ‍electrolytes, ‍creatinine, ‍blood gas

- Sputum culture

- Pulmonary function tests

- Increase dose of rescue inhaler

- If mild increase shortness of breath, dougle dose of inhaled corticosteroids: ‍Inhaled corticosteroids (ICS)

- If moderate increase shortness of breath, add oral corticosteroids: ‍Prednisone

- If change in sputum color, add antibiotics: ‍Antibiotics

- Oxygen therapy if SpO2 < 90-92%

- Ensure proper inhalation technique and spacer use

- Smoking cessation counseling

- Immunization: pneumococcal, annual influenza, covid

- Referral to pulmonologist

- Follow-up in ‍ ‍monthsyears

- Return sooner if symptoms do not improve in 72h or if symptoms worsen

- Go to ER if severe shortness of breath, chest pain, or high fever