The clinical course of COPD is divided into stable and acute exacerbation of COPD (AECOPD) according to the clinical characteristics of COPD. The so-called AECOPD refers to the exacerbation of the disease on the basis of the daily stable clinical symptoms of COPD, accompanied by wheezing, chest tightness, worsening of cough, increase in sputum volume, change in sputum color and/or viscosity, and even fever, etc. In some patients, there may also be non-specific symptoms, such as tachycardia, shortness of breath, general malaise, insomnia, somnolence, fatigue, depression, and mental disorders, etc. The clinical course of COPD is classified into two stages according to the clinical characteristics of COPD: the acute exacerbation stage and the chronic phase.

AECOPD is a clinical emergency or serious condition, but there is no uniform, clinically applicable objective standard for its severity. According to the characteristics of clinical symptoms and laboratory test results of AECOPD patients, and according to the required treatment means and the need for hospitalization, AECOPD is classified into 3 levels by foreign professional organizations, i.e., level I: mild symptoms, requiring only outpatient treatment; level II: serious but not life-threatening condition, requiring hospitalization in general wards; and level III: extremely serious symptoms, with respiratory failure, life-threatening, requiring hospitalization in ICUs. Class III: extremely serious symptoms, respiratory failure, life-threatening, requiring ICU treatment.

Regardless of the level of AECOPD, the basic treatments are the same, but are selected and focused according to the severity of clinical symptoms and risk. These treatments include:

controlled oxygen therapy (COT)

Oxygen therapy is the basic treatment for hospitalized patients with AECOPD, and some outpatients may also use home oxygen therapy. The so-called controlled oxygen therapy means that the concentration of inhaled oxygen should not be too high, generally less than 35% (normal human inhalation of atmospheric oxygen concentration of 21%); too high a concentration of inhaled oxygen will inhibit respiration, leading to more severe hypoxia.

medication

These mainly include bronchodilators, glucocorticoids, antimicrobials (including antivirals) and respiratory stimulants.

Bronchodilators are central and fundamental to the treatment of COPD, as they are in AECOPD. Short- or long-acting β2 agonists, such as salbutamol and salmeterol, and short- or long-acting anticholinergics, such as ipratropium bromide and tiotropium bromide, are available, as well as theophylline preparations in some patients.

Antibiotics, on the other hand, need to be selected based on the presence of a pathogenic bacterial infection and which type of pathogenic bacterial infection is present. Empirical antiviral therapy is generally not advocated unless flu-like symptoms are present. Glucocorticoids are mostly used in critically ill patients.

In hospitalized patients, attention should be paid to the stability of the internal environment, maintenance of water and electrolyte balance, and active expectoration. Concomitant diseases (e.g., coronary artery disease, diabetes mellitus, hypertension) and complications (e.g., shock, diffuse intravascular coagulation, and upper gastrointestinal hemorrhage) should also be recognized and treated.

mechanical ventilation

AECOPD patients with respiratory failure that does not improve with the above treatments or with progressive exacerbation of respiratory failure require prompt mechanical ventilation. These patients usually need to be hospitalized, and those who require tracheal intubation and invasive mechanical ventilation need to be admitted to the ICU.

As for which mode of mechanical ventilation to choose (noninvasive? invasive?) ), as well as how to select and adjust the parameters of the ventilator, need to be carried out by professionals, the purpose of which is to ensure that there is a sufficient level of oxygen in the body and to eliminate the carbon dioxide stored in the body. In clinical practice, some patients with stable COPD can choose to use home non-invasive ventilator-assisted ventilation, which can also achieve good results.

Management of AECOPD complications

In patients with severe AECOPD, they often have multiple comorbidities or a predisposition to complications, such as heart failure and pulmonary embolism. Enhanced early prognosis, diagnosis and treatment of complications can improve the prognosis of these patients. Of course, these also need to be carried out by medical professionals.

I'll start with what are the signs of chronic obstructive pulmonary disease (COPD)?

1、Cough Generally morning cough is the main, sleep with bouts of cough or sputum.

Coughing sputum is usually white mucus and foamy sputum, occasionally with blood. More sputum is discharged in the morning, and the change of body position when getting up can stimulate the discharge of sputum.

Shortness of breath or dyspnea occurs in the early stages during labor, and then gradually worsens to the point where shortness of breath is felt during daily activities and even at rest, which is the hallmark symptom of COPD.

4, wheezing and chest tightness Wheezing occurs in some patients, especially in severe patients or in acute exacerbations.

5、Others Late-stage patients have weight loss and loss of appetite.

The course of chronic obstructive pulmonary disease can be divided into acute exacerbation and stable phase.

Manifestations of acute exacerbation: refers to a short-term worsening of cough, sputum, shortness of breath and/or wheezing, increased sputum volume, purulent or mucopurulent sputum, which may be accompanied by fever, etc.

Stable phase manifestation: refers to the patient's cough, sputum, shortness of breath and other symptoms are stable or milder.

In summary, the most common trigger for an acute exacerbation of COPD is an acute lung infection, which may be accompanied by fever. The patient's self-consciousness that the sputum has become purulent, and that breathing is more difficult, etc. are all indicative of an exacerbation of the disease.

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Chronic Obstructive Pulmonary Disease (COPD), also known as chronic obstructive pulmonary disease (COPD), is a disease related to internal medicine, respiratory medicine, a disease that is harmful to the human body, a destructive lung disease that is particularly sensitive to pollution and particles in daily life, and a disease that is characterized by incomplete and reversible restriction of airflow. So what causes lentigo?

There is no specific cause of chronic obstructive pulmonary disease, but a variety of factors in life can trigger chronic obstructive pulmonary disease, can trigger chronic bronchitis and directly trigger chronic obstructive pulmonary disease. Among them, smoking is the most important morbidity factor leading to chronic obstructive pulmonary disease, smoke will directly affect the health of the lungs, if roaming chronic obstructive pulmonary disease, then it will aggravate its condition. There is also due to the influence of dust and chemical substances in the air, such as some smoke and air pollution, industrial exhaust, etc., the concentration is too large and stay for too long will aggravate the condition. Air pollution, including atmospheric carbon dioxide, nitrogen dioxide and chlorine will damage the mucous membrane of the airways, which will indirectly cause the airway cilia to reduce the ability to clear, more susceptible to bacterial infections and exacerbate the chronic obstructive pulmonary disease. There is also a direct infection rather the condition is infected and aggravated. Since there are so many factors in life that can aggravate COPD, what are the ways to recognize acute exacerbation of COPD in time?

In fact, it is to pay more attention to hygiene and do not go to some dust and pollution more places, usually pay more attention, do not be careless, a moment of carelessness may cause the condition to worsen. When you feel uncomfortable, you should seek medical treatment in time and ask your doctor for specific preventive programs. Generally, when the chronic obstructive pulmonary disease is aggravated, the body will have some discomfort, it should be easy to distinguish.

Instructor: Lu Xiaohe, Associate Chief Physician, Department of Cardiothoracic Surgery, Maanshan People's Hospital.

He specializes in the surgical treatment of esophageal cancer, lung cancer, small lung nodules, mediastinal tumors, pneumothorax and other common diseases in thoracic surgery.

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First of all, thank you for your question. Here is a brief overview of acute exacerbation of chronic obstructive pulmonary disease.

Clinically, acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a process of acute onset in which a patient with chronic obstructive pulmonary disease experiences an acute exacerbation of respiratory symptoms (typically worsening of dyspnea, worsening of cough, increased sputum volume and/or purulent sputum) that goes beyond daily variability and results in the need for a change in drug therapy. AECOPD is a diagnosis of clinical exclusion, with no other explanatory specific disease (e.g., pneumonia, congestive heart failure, pneumothorax, pleural effusion, pulmonary embolism, and cardiac arrhythmia) detected by clinical and laboratory tests. With treatment, worsening respiratory symptoms may or may not improve, and typical symptoms resolve within days to weeks. Acute exacerbations occur about 0.5 to 3.5 times per year in patients with COPD, and they are an important factor in death in patients with COPD.

The main symptoms of acute exacerbation of COPD are increased shortness of breath, often accompanied by wheezing, chest tightness, worsening cough, increased sputum volume, change in sputum color or viscosity, and fever. In addition, non-specific symptoms such as tachycardia, shortness of breath, general malaise, insomnia, drowsiness, fatigue, depression and mental disorders may occur. Decreased exercise tolerance, fever, or chest imaging abnormalities may also be indicative of exacerbation of chronic obstructive pulmonary disease (COPD). According to the Chinese Expert Consensus on the Diagnosis and Treatment of AECOPD (2017), the diagnosis of acute exacerbation of chronic obstructive pulmonary disease is currently completely dependent on clinical manifestations. Therefore, when patients have dyspnea, cough and sputum, they need to pay enough attention, and it is recommended that they go to a regular medical institution as soon as possible for consultation.

I hope the above answer can help you.

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Definition of acute exacerbation of chronic obstructive pulmonary disease

An acute exacerbation of chronic obstructive pulmonary disease (COPD) is an acute worsening of respiratory symptoms (cough, sputum, dyspnea) that results in the need for additional treatment.

Exacerbations can be triggered by smoking, infections, air pollution, cold air irritation, sudden discontinuation of medication, having surgery, and use of anesthetics.

Acute exacerbations are categorized into three grades

1. Mild, requiring the use of a short-acting bronchodilator, albuterol.

2. Moderate, requiring antibiotics or oral hormones.

3. Severe, requiring hospitalization.

How to recognize an acute exacerbation

Recognizing an acute exacerbation depends primarily on symptoms.

1. Increased coughing

2. Increased cough and sputum

3. Increased dyspnea

Additional medications are needed. If albuterol, antibiotics or hormones are used to treat it, then an acute exacerbation has occurred.

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Chronic Obstructive Pulmonary Disease (COPD) and Chronic Obstructive Pulmonary Disease (COPD) are characterized by completely irreversible airflow limitation. The airflow limitation in COPD is progressively worsening and is accompanied by an inflammatory response of the lungs to harmful particles or gases mainly caused by smoking. Chronic obstructive pulmonary disease poses a serious risk to the patient, especially in acute exacerbations, and prompt therapeutic measures must be taken.

In most cases acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with infections in the lungs or in the body. Infections are usually caused by viruses, but can also be caused by bacteria or other pathogens. Inflammation within the lungs due to infection can lead to narrowing of the airways, swelling of the airways and production of mucus to block the airways. Acute exacerbations can also come from irritants in the environment.

Signs and symptoms of an acute exacerbation are associated with a change in the patient's condition and include increased wheezing, persistent cough, increased shortness of breath, more latent or faster breathing than usual, increased mucus production, change in mucus color, which may be yellow, green, tan, or feverish with blood, altered consciousness or lethargy, and swelling of the feet or ankles.

Chronic obstructive pulmonary disease should be treated aggressively and correctly during acute exacerbations, and its treatment should include maintaining the usual airway, removing triggers, and improving hypoxia.

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Hello, I'm Dr. Li Xiaorong of Chinese Medicine and Lung Disease, chronic obstructive pulmonary disease in the acute exacerbation period, the body will have a lot of uncomfortable symptoms, and I hope to cause chronic obstructive pulmonary disease patients and friends attention.

Chronic obstructive pulmonary disease (COPD) is associated with the development of abnormal inflammation in the lungs due to factors such as prolonged smoking and exposure to polluted air.

When a patient presents withWheezing, chest tightness, increased cough, increased sputum volume, changes in sputum consistency and color, and tachycardia, drowsiness, cyanosis, confusion, depression, and mental disorders.When these conditions, it also indicates that the chronic obstructive pulmonary disease has entered the acute exacerbation stage, the patient must seek timely medical treatment.

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What is an acute exacerbation of COPD? When a COPD patient's cough, sputum, shortness of breath, or shortness of breath suddenly worsens, this is likely to be an "acute exacerbation of COPD".

Acute exacerbation of chronic obstructive pulmonary disease is very dangerous. Acute exacerbation of chronic obstructive pulmonary disease not only leads to aggravation of pulmonary symptoms, but also leads to decline in lung function, quality of life, and aggravates the economic burden, etc., so we have to pay attention to this disease.

When patients with chronic obstructive pulmonary disease have a disease exacerbation patients often have a short-term cough, cough sputum, shortness of breath and/or wheezing aggravation, increased sputum, purulent or mucopurulent sputum, may be accompanied by fever and other manifestations of inflammation significantly aggravated.

The reasons for this condition are often poor treatment during the stabilization period and environmental changes. Bacterial viral infections, etc.

Therefore, patients with chronic obstructive pulmonary disease, whether in remission or acute exacerbation, should pay attention to the treatment, and more attention should be paid to preventive care in normal times!

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