INDEX

    Chronic Obstructive Pulmonary Disease (COPD) – Diagnosis

    Respiratory

    Last Updated Jan 06, 2020
    Read Disclaimer

    Context

    • Acute exacerbations of COPD (AECOPD) defined as worsening dyspnea, cough, and/or sputum production; which leads to a change in treatment.
    • Fourth leading cause of death worldwide.
    • Approximately 138,500 individuals ≥ 45 years old in BC have COPD – underdiagnosed.
    • AECOPD identifies patients with a significantly higher mortality risk compared to stable COPD patients.
    • 20% require hospitalization.

    Diagnostic Process

    AECOPD is a clinical diagnosis, several scoring systems have been created (Ottawa COPD severity score, DECAF, and BAP-65) but none have sufficient sensitivity/specificity to be used routinely.

    Most of the patients with mild to moderate exacerbations do not come to the ED.

    Important historical factors

    • comorbid conditions
    • drugs – prescribed and illicit
    • smoking history
    • previous exacerbations, including treatment required
    • need for mechanical ventilation, and
    • frequency of hospitalizations.

    Triggers

    • Infections (virus or bacteria) most common
    • Environmental – irritants and extreme weather
    • Left ventricular failure
    • Sputum retention (chest trauma – poor inspiration, diminished cough reflex)
    • Pulmonary embolism
    • Pneumothoraces, and
    • Medications such as opioids, beta-blockers, antihistamines, antitussives, diuretics.

    Vital signs

    • Tachypnea
    • Tachycardia
    • Hypoxia/cyanosis)
    • Respiratory effort/accessory muscle use and mental status

    Evidence of respiratory fatigue.

    Tests

    Blood gases

    • Venous gases
      • pH and pCO2 correlate well with arterial blood gases.

    Monitoring for hypercapnia after the initiation of supplemental oxygen. VBG, mental status and respiratory drive).

    Chest X-Ray

    • Precipitating causes (i.e pneumonia).
    • Differential diagnosis (infiltrates, lung masses, pneumothoraces, pulmonary edema, etc).

    Point-of-care ultrasound can quickly narrow the differential diagnosis for dyspnea

    • heart, lungs, and deep veins.

    ECG

    • Arrhythmia and/or ischemia
    • ECG findings with COPD: (link to ECG )
      • Right heart strain
      • RV hypertrophy
      • P pulmonale
      • RAD, RBBB
      • ST depression or inversion in V1-V3.

    Consider

    • Troponin
    • BNP or NT- proBNP
    • Sputum Gram stain and culture
    • Respiratory viral swab
    • CT Chest.

    If the patient fails to improve, consider pulmonary embolism and CHF.

    Clinical Pathway

    CLICK TO ENLARGE

    Copyright © 2017 EB Medicine.

    Quality Of Evidence?

    Justification

    Moderate

    Related Information

    Reference List

    Relevant Resources

    RELEVANT CLINICAL RESOURCES

    View all Resources

    RELEVANT VIDEO

    04:53

    Noninvasive Positive Pressure Ventilation (BiPAP/CPAP)

    View all Videos

    RESOURCE AUTHOR(S)

    COMMENTS (0)

    Add public comment…