Pulmonary Disorders II
Diagnosis of ECOPD
Symptoms, severity of dyspnea using a visual analog scale, and documentation of the presence of
cough should be assessed.
Signs (tachypnea, tachycardia), sputum volume and color, and respiratory distress (accessory
muscle use) should also be assessed.
Severity should be evaluated with Spo2, C-reactive protein (CRP), and ABG (venous blood gas to
assess pH and bicarbonate is an acceptable alternative).
| d. | Identify the etiology of the event (viral, bacterial, or environmental). |
|---|
Spirometry is not accurate during an exacerbation and is not recommended.
Assess for other etiologies that may explain a patient’s symptoms (ie, pneumonia, heart failure,
pulmonary embolism).
Classifications of ECOPD
ECOPD Severity
Description
Diagnostic Parameters
Mild
Treated with
short-acting
bronchodilators
only
Patient must exceed three of the listed variables to move to moderate
| • | Dyspnea VAS < 5 |
|---|---|
| • | RR < 24 breaths/min |
| • | HR < 95 beats/min |
| • | Resting Spo2 ≥ 92% breathing ambient air (or patient’s usual |
oxygen prescription) AND change ≤ 3%a
| • | CRP < 10 mg/L (if available) |
|---|
Moderate
Treated with
short-acting
bronchodilators
and oral
corticosteroids
with or without
the addition of
antibiotics
| • | Dyspnea VAS ≥ 5 |
|---|---|
| • | RR ≥ 24 breaths/min |
| • | HR ≥ 95 beats/min |
| • | Resting Spo2 < 92% breathing ambient air (or patient’s usual |
oxygen prescription) AND/OR change > 3%a
| • | CRP ≥ 10 mg/L (if available) |
|---|---|
| • | If ABG obtained, hypoxemia and/or hypercapnia may be present |
(Pao2 ≤ 60 mm Hg, Paco2 > 45 mm Hg), but acidosis will be absent
Severe
Patient requires
ED visit or
hospitalization;
patient may also
experience acute
respiratory failure
| • | Dyspnea, RR, HR, Sao2, and CRP parameters identical to those for |
|---|
moderate severity
| • | ABG shows new hypercapnia and acidosis (Paco2 > 45 mm Hg and |
|---|
pH < 7.35)
aPulse oximetry (Spo2) is not as accurate as an ABG, and there is a risk of overestimation of blood oxygenation saturation in patients with darker skin tones (N Engl J
Med 2020;383:2477-8).
ABG = arterial blood gas; CRP = C-reactive protein; ECOPD = exacerbations of chronic obstructive pulmonary disease; ED = emergency department; HR = heart rate;
RR = respiratory rate; Sao2 = oxygen saturation; Spo2 = functional oxygen saturation; VAS = visual analog scale.