COPD QRG Acute Care

COPD National Strategy Quick Reference Guide
COPD Acute Care

Recommendation 17: The quality of the identification and management of exacerbations should be improved and all people with COPD who have an exacerbation should be reviewed afterwards to ensure that their treatment remains optimal and relapses are reduced to a minimum.

Recommendation 18: All people with COPD in respiratory failure should be issued with oxygen alert cards, and ambulance staff should be able to recognise and respond appropriately to respiratory failure in COPD.

Recommendation 19 People with COPD should receive a specialist respiratory review when acute episodes have required referral to hospital. They should be assessed for management by early discharge schemes, or by a structured hospital admission, to ensure that length of stay and subsequent readmission are minimised.

Acute exacerbations
An exacerbation of COPD is a sustained worsening of an individual’s symptoms (increased breathlessness, cough, and purulent sputum) from their usual stable state which is rapid in onset. Assessment should include:

Level of consciousness
Degree of breathlessness
Degree of hypoxaemia
Ability to cope at home

Other conditions which should be considered include pneumonia, pneumothorax, pulmonary embolus and cardiac failure.

Oxygen alert cards
COPD patients at risk of developing hypercapnia should carry oxygen alert cards to alert clinicians and ambulance staff to avoid high flow oxygen in future exacerbations.

Admission prevention
“Hospital at home” provided by specialist community teams or hospital outreach teams can reduce hospital admissions and/or length of stay. Telemedicine may enable early identification and treatment of exacerbations, and reduce the risk of hospital admission.

Review post-exacerbation
A review should be provided within 6 weeks of an exacerbation, or within 3 weeks of an admission to prevent early readmission. The aim of a review is to:

Optimise management including pharmacotherapy, provision of oxygen and pulmonary rehabilitation where appropriate
Optimise psychosocial support
Reinforce self-management skills
After an admission, consider possible palliative care needs

Further resources