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A Journal on Diseases of the Respiratory System

Official Journal of the Italian Society of Thoracic Endoscopy
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Minerva Pneumologica 2004 September;43(3):123-30

language: English

Chronic obstructive pulmonary disease exacerbation. Definition, evaluation and treatment

Donner C. F.


A working classification based on severity of chronic obstructive pulmonary disease (COPD) exacerbation, useful in ranking the clinical relevance of the episode and its outcome, is as follows: home treatment (level 1), hospitalisation (level 2), hospitalisation with respiratory failure (level 3). On this basis it is possible to define the clinical history, clinical evaluation and diagnostic procedures of an exacerbation. Treatment guidelines vary in relation to the severity but they are essentially based on adequate bronchodilator therapy (b2 agonists and/or anticholinergics, corticosteroids and antibiotics selected according to the local bacterial resistance pattern). A particularly important aspect is the identification of cases requiring admission to and management in an intermediate/special respiratory care unit or intensive care unit (ICU). It is at this stage that oxygen therapy and ventilatory support become particularly important; as first choice they should be noninvasive leaving intubation and invasive ventilatory support to the most severe cases characterised by severe acidemia and hypercapnia. We identify the optimal criteria for hospital discharge and follow-up of the patient, which, in view of the chronic nature of the underlying disease, is fundamental to avoid frequent and repeated relapses.

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