Chronic Obstructive Pulmonary Disease, or COPD, is a chronic airway condition in which patients have a chronic cough and expectoration with varying degrees of shortness of breath. An exacerbation means there is a change in the patient's normal day-to-day breathing status. During an exacerbation, the patient will experience worsening of their symptoms which will usually require a change in their regular medication.
Exacerbation Symptoms
According to "The Nurse Practitioner," the common presentation for a patient with COPD exacerbation is an increased shortness of breath. The shortness of breath will also be accompanied by wheezing, chest tightness and fever. The patient will complain of an increased cough with sputum production.
Oxygen Therapy
Patients with COPD exacerbation may require additional oxygen support. Mild cases may need only small amounts of oxygen that can be delivered by a nasal cannula. Depending on the severity of the exacerbation, some patients may need more oxygen than can be given by a nasal cannula. In severe cases, a patient may need to have a tube placed through the mouth into the trachea, which is connected to a machine that will breath for them.
Bronchodilator Medications
Bronchodilator medications are used in the treatment of COPD exacerbation. These medications cause rapid relaxation of the smooth muscles in the lungs which results in dilation of the airways to improve oxygenation. Bronchodilator medications are usually administered by a nebulizer that creates a mist that the patient will inhale during breathing.
Anticholinergic Medications
During an acute exacerbation, anticholinergic medications are used to relax and dilate the airways of the lungs. Anticholinergics help protect the airway from spasms that cause narrowing of the airways. These medications also help to reduce the amount of mucous produced in the airways. Anticholinergics are usually given in combination with a bronchodilator.
Steroid Medication
Steroid medications are used during an acute exacerbation to help decrease inflammation or swelling. According the "Current Diagnosis and Treatment: Emergency Medicine," steroids are crucial to reduce the rate of relapse in exacerbations.
Antibiotics and Admission
Patients who present with worsening shortness of breath, cough and increased sputum production may benefit from antibiotics. If their COPD exacerbations are slow to resolve, hey may require hospital admission for monitoring. Patients with COPD commonly have accompanying problems such as pneumonia or heart failure, which can make management more complicated. Patients with COPD exacerbation are usually in need of hydration. Intravenous fluids are given for hydration but, if the patient has heart disease, must be monitored closely to prevent fluid overload.
References
- "Core Curriculum for Critical Care Nursing"; Joann Alspach, editor; 2006
- "The Nurse Practitioner"; 'Gold' Standards for Acute Exacerbation in COPD"; Donna Chojnowski; May 2003
- "Current Diagnosis and Treament: Emergency Medicine"; C. Keith Stone, Roger L. Humphries; 2008
