Skip to main content
WoMWeb of Medicine
SearchGraphHistory
Internal Medicine›Condition·Updated Apr 17, 2026·v1

COPD Exacerbation

AECOPD is a major clinical event requiring a structured approach to bronchodilation, short-course steroids, and oxygen management. NIV is essential for hypercapnic failure, while POCUS and biomarkers like PCT and eosinophils guide targeted therapy and rule out mimics.

High Evidence113 references·5,410 words·22 min read·v1
COPDAECOPDPulmonologyRespiratory FailureNIV

Quick Reference

RxDrug of choiceSABA (Salbutamol) + SAMA (Ipratropium) + Systemic Corticosteroids (Prednisone 40 mg)
AltAlternativesNebulized Budesonide 2 mg (if systemic steroids contraindicated); Macrolides or Amoxicillin/Clavulanate (for antibiotics)
⊘AvoidHigh-flow oxygen without monitoring (risk of hypercapnic respiratory failure); long-term steroid tapers (>5 days)
DxTest of choiceArterial Blood Gas (ABG) for severity; POCUS for differential diagnosis
ScKey scoreAnthonisen Criteria (Symptom-based); GOLD Severity Classification (Intervention-based)
→When to referpH <7.25, altered mental status, hemodynamic instability, or failure of NIV
Treat AECOPD with 5 days of prednisone, targeted antibiotics for purulent sputum, and NIV for respiratory acidosis, while maintaining SpO2 at 88-92%.
An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a critical clinical event characterized by a sustained worsening of respiratory symptoms—specifically dyspnea, cough, and sputum production—that necessitates a change in regular medication. These episodes are not merely temporary setbacks but are major drivers of disease progression, permanent lung function decline, and increased mortality. Management focuses on rapid reversal of airflow obstruction using bronchodilators, reducing systemic inflammation with short-course corticosteroids, and treating infectious triggers with targeted antibiotics. For patients presenting with acute hypercapnic respiratory failure, non-invasive ventilation (NIV) is the gold standard of care. Clinicians must maintain a high index of suspicion for mimics such as acute heart failure and pulmonary embolism, which frequently coexist with or masquerade as AECOPD.

Overview and Recommendations

Background

  • •Define an acute exacerbation (AECOPD) as a clinical event characterized by increased , cough, or sputum production beyond daily variations that requires a change in therapy.
  • •Recognize the primary triggers, which include respiratory viruses (Rhinovirus is most common, followed by Influenza and RSV), bacterial pathogens (Nontypeable Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis), and environmental pollutants.
  • •Understand the clinical impact of exacerbations, which drive the "multidimensional progression" of , often leading to a permanent loss of lung function and increased risk of future cardiovascular events for up to 6 months post-discharge.
  • •Classify exacerbations by severity based on the required intervention: Mild (treated with short-acting bronchodilators only), Moderate (requires oral corticosteroids and/or antibiotics), and Severe (requires hospitalization or emergency department evaluation).
  • •Identify high-risk phenotypes, such as patients with frequent exacerbations (≥2 per year), those with underlying frailty, or those with comorbid , all of whom face significantly higher mortality and readmission rates.

Evaluation

  • •Suspect AECOPD in any patient with known COPD presenting with the Anthonisen triad: increased dyspnea, increased sputum volume, and increased sputum purulence.
  • •Ask about the prodromal phase, specifically looking for subtle increases in cough or changes in sputum color that preceded the acute escalation of symptoms.
  • •Examine the patient for signs of respiratory distress, including accessory muscle use, paradoxical chest wall movement, and the presence of new wheezing or crackles on auscultation.
  • •Obtain immediate and target an initial saturation of 88–92% while awaiting further diagnostic testing.
  • •Order an Arterial Blood Gas (ABG) for any patient with SpO2 <92%, significant respiratory distress, or altered mental status to identify acute (pH <7.35 and PaCO2 >45 mmHg).
  • •Perform Point-of-Care Ultrasound (POCUS) using the EMERALD-US protocol to rapidly differentiate AECOPD from (look for B-lines) and pneumonia (look for consolidation).
  • •Rule out pulmonary embolism (PE) in patients with unexplained exacerbations, pleuritic chest pain, or dyspnea out of proportion to clinical signs, using D-dimer or CT (CTPA).
  • •Order a Chest X-ray (CXR) to screen for concomitant pneumonia, which occurs in approximately 48.7% of hospitalized AECOPD cases, or to rule out a .
  • •Check admission blood eosinophil counts; levels <100 cells/µL are associated with higher inpatient mortality and may suggest a lower likelihood of response to corticosteroids.
  • •Utilize serum procalcitonin (PCT) to guide antibiotic therapy; consider withholding antibiotics if PCT <0.1 ng/mL and strongly encourage them if PCT >0.25 ng/mL.
  • •Obtain an ECG and NT-proBNP to screen for acute cardiovascular events (CVEs), such as new-onset or left ventricular dysfunction, which are common during the acute phase.
  • •Apply the 5-item CERT checklist to confirm the diagnosis; a score of ≥2 moderate-to-severe items is considered positive for an exacerbation.

Management

  • •Administer short-acting β2-agonists (SABA) such as Salbutamol 2.5–5 mg via nebulization every 1–4 hours as needed for rapid bronchodilation.
  • •Combine SABA with a short-acting muscarinic antagonist (SAMA) like Ipratropium bromide 0.5 mg every 4–6 hours, as the combination is superior to monotherapy in reducing hospitalizations.
  • •Prescribe systemic corticosteroids to improve FEV1 and shorten hospital stay; the standard regimen is Prednisone 40 mg orally once daily for exactly 5 days.
  • •Consider nebulized Budesonide 2 mg every 6 hours as an alternative to systemic steroids if the patient has contraindications to oral/IV glucocorticoids or to reduce systemic side effects.
  • •Initiate empiric antibiotics for patients with increased sputum purulence or those requiring mechanical ventilation; first-line options include Amoxicillin/Clavulanate 875/125 mg BID or Azithromycin 500 mg on day 1 followed by 250 mg daily for 5 days.
  • •Maintain controlled oxygen therapy to a target SpO2 of 88–92%; avoid high-concentration oxygen which can worsen hypercapnia via the Haldane effect and ventilation-perfusion mismatch.
  • •Initiate Non-Invasive Ventilation (NIV) for patients with respiratory acidosis (pH <7.35) or persistent dyspnea despite medical therapy; start with BiPAP at IPAP 10–12 cm H2O and EPAP 4–5 cm H2O.
  • •Monitor ABG within 1–2 hours of starting NIV; if pH remains <7.30 and the patient is not improving, escalate to intensive care for possible .
  • •Utilize High-Flow Nasal Oxygen (HFNO) as a comfortable alternative to NIV in patients with mild-to-moderate hypercapnic respiratory failure (pH 7.25–7.35).
  • •Avoid the use of morphine for anxiety in patients with concomitant COPD and heart failure; midazolam is preferred if sedation is absolutely necessary for NIV tolerance.
  • •Transition the patient to long-acting bronchodilators, such as Tiotropium 18 µg daily or Salmeterol 50 µg BID, before hospital discharge to prevent early recurrence.
  • •Implement early mobilization and rehabilitation, such as using a pedal exerciser during the hospital stay, to improve muscle strength and balance.
  • •Provide nutritional support for malnourished patients, specifically high-protein supplements containing beta-hydroxy-beta-methylbutyrate (HP-HMB) twice daily.
  • •Refer patients with significant functional impairment or slow gait speed to rapid access rehabilitation (RAR) programs upon discharge.
  • •Ensure a follow-up appointment within 1–2 weeks of discharge to assess the Assessment Test (CAT) score and adjust maintenance therapy.

Board Review — High Yield

  • •Anthonisen Criteria — Diagnosis requires increased dyspnea, sputum volume, and sputum purulence.
  • •Target SpO2 — 88–92% is the goal to prevent worsening hypercapnia and acidosis.
  • •REDUCE Trial — Established that 5 days of systemic corticosteroids is non-inferior to 14 days for AECOPD.
  • •Eosinophils — Low admission counts (<100 cells/µL) are a marker of poor prognosis and reduced steroid response.
  • •NIV Indications — pH <7.35 and PaCO2 >45 mmHg; it reduces the need for intubation and decreases mortality.
  • •Rhinovirus — The most frequently identified viral trigger for acute exacerbations.
  • •Procalcitonin — A validated tool to reduce unnecessary antibiotic use; withhold if <0.1 ng/mL.
  • •Pulmonary Embolism — Found in up to 25% of patients hospitalized with unexplained COPD exacerbations.

Deep Dive — Evidence Details

References

  1. [1]

    Effing TW, Kerstjens HAM, Monninkhof EM et al.. “Definitions of exacerbations: does it really matter in clinical trials on COPD?” Chest (2009). PMID: 19736196 ↗

    L2bTRIAL_NONRANDOMCited in: Definition, Synonyms, and Classification
  2. [2]

    Gandhi A, Walsh EE, Formica MA et al.. “Factors associated with symptomatic rhinovirus infection in patients with COPD.” Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology (2012). PMID: 22999488 ↗

    L5OTHERCited in: Definition, Synonyms, and Classification
  3. [3]

    Soler-Cataluña JJ, Martínez-García MÁ, Serra PC. “[Multidimensional impact of COPD exacerbations].” Archivos de bronconeumologia (2010). PMID: 21316556 ↗

    L5REVIEW_NARRATIVECited in: Definition, Synonyms, and Classification
  4. [4]

    Huang T, Xu Z, Xu A et al.. “In-depth comparative pathogenome, virulome, and resistome analysis of an extensive drug resistant Ralstonia mannitolilytica strain isolated from blood.” Microbial pathogenesis (2024). PMID: 39306054 ↗

    L5OTHERCited in: Definition, Synonyms, and Classification
  5. [5]

    Makris D, Bouros D. “COPD exacerbation: lost in translation.” BMC pulmonary medicine (2009). PMID: 19178701 ↗

    L5OTHERCited in: Definition, Synonyms, and Classification
  6. [6]

    Su J, Liu HY, Tan XL et al.. “Sputum Bacterial and Fungal Dynamics during Exacerbations of Severe COPD.” PloS one (2015). PMID: 26147303 ↗

    L5OTHERCited in: Definition, Synonyms, and Classification
  7. [7]

    Figliozzi S, Masci PG, Ahmadi N et al.. “Predictors of adverse prognosis in COVID-19: A systematic review and meta-analysis.” European journal of clinical investigation (2020). PMID: 32726868 ↗

    L2aSR_OBSCited in: Etiology and Triggering Factors, Diagnosis and Workup, Management: Pharmacological Therapy, Management: Respiratory Support, Prognosis and Long-term Outcomes
  8. [8]

    Beck da Silva Etges AP, Marcolino MAZ, Bianchini L et al.. “Economic analysis of high-flow nasal oxygen compared with noninvasive ventilation in patients with acute respiratory failure: results from the RENOVATE randomized clinical trial.” Respiratory medicine (2025). PMID: 40744283 ↗

    L1bRCTCited in: Etiology and Triggering Factors, Management: Respiratory Support
  9. [9]

    Maia IS, Kawano-Dourado L, Tramujas L et al.. “High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial.” JAMA (2025). PMID: 39657981 ↗

    L1bRCTCited in: Etiology and Triggering Factors, Diagnosis and Workup, Management: Respiratory Support, Prognosis and Long-term Outcomes
  10. [10]

    Pasqua F, Biscione G, Crigna G et al.. “Prulifloxacin in the treatment of acute exacerbations of COPD in cigarette smokers.” Therapeutic advances in respiratory disease (2008). PMID: 19124373 ↗

    L2bTRIAL_NONRANDOMCited in: Etiology and Triggering Factors
  11. [11]

    Cintora-Sanz AM, Horrillo-García C, Quesada-Cubo V et al.. “Prevalence and Economic Impact of Acute Respiratory Failure in the Prehospital Emergency Medical Service of the Madrid Community: Retrospective Cohort Study.” JMIR public health and surveillance (2025). PMID: 39819841 ↗

    L2bCOHORTCited in: Etiology and Triggering Factors
  12. [12]

    Ko FW, Ip M, Chan PK et al.. “A one-year prospective study of infectious etiology in patients hospitalized with acute exacerbations of COPD and concomitant pneumonia.” Respiratory medicine (2008). PMID: 18573648 ↗

    L2bCOHORTCited in: Etiology and Triggering Factors
  13. [13]

    van Geffen WH, Bruins M, Kerstjens HA. “Diagnosing viral and bacterial respiratory infections in acute COPD exacerbations by an electronic nose: a pilot study.” Journal of breath research (2016). PMID: 27310311 ↗

    L2bTRIAL_NONRANDOMCited in: Etiology and Triggering Factors
  14. [14]

    Nishimura K, Nishimura T, Oga T. “Streptococcus pneumoniae urinary antigen test and acute exacerbations of chronic obstructive pulmonary disease.” COPD (2012). PMID: 22452423 ↗

    L2bTRIAL_NONRANDOMCited in: Etiology and Triggering Factors
  15. [15]

    Menon B, Gurnani M, Aggarwal B. “Comparison of outpatient visits and hospitalisations, in patients with chronic obstructive pulmonary disease, before and after influenza vaccination.” International journal of clinical practice (2008). PMID: 18284444 ↗

    L2bTRIAL_NONRANDOMCited in: Etiology and Triggering Factors
  16. [16]

    Clancy RL, Cripps AW. “An Oral Whole-Cell Killed Nontypeable Haemophilus influenzae Immunotherapeutic For The Prevention Of Acute Exacerbations Of Chronic Airway Disease.” International journal of chronic obstructive pulmonary disease (2019). PMID: 31695359 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors, Management: Pharmacological Therapy
  17. [17]

    Leung JM, Tiew PY, Mac Aogáin M et al.. “The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD.” Respirology (Carlton, Vic.) (2017). PMID: 28342288 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors
  18. [18]

    Ritchie AI, Farne HA, Singanayagam A et al.. “Pathogenesis of Viral Infection in Exacerbations of Airway Disease.” Annals of the American Thoracic Society (2015). PMID: 26595727 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors
  19. [19]

    Sasaki T, Nakayama K, Yasuda H et al.. “A new strategy with proton pump inhibitors for the prevention of acute exacerbations in COPD.” Therapeutic advances in respiratory disease (2011). PMID: 21285157 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors
  20. [20]

    Papaetis GS, Anastasakou E, Orphanidou D. “Chlamydophila pneumoniae infection and COPD: more evidence for lack of evidence?” European journal of internal medicine (2009). PMID: 19782917 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors
  21. [21]

    Cazzola M, Rogliani P, Curradi G. “Bacterial extracts for the prevention of acute exacerbations in chronic obstructive pulmonary disease: a point of view.” Respiratory medicine (2008). PMID: 18164190 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors
  22. [22]

    Hutchinson AF, Ghimire AK, Thompson MA et al.. “A community-based, time-matched, case-control study of respiratory viruses and exacerbations of COPD.” Respiratory medicine (2007). PMID: 17822891 ↗

    L3bCASE_CONTROLCited in: Etiology and Triggering Factors
  23. [23]

    Greenberg SB. “Rhinovirus and coronavirus infections.” Seminars in respiratory and critical care medicine (2007). PMID: 17458772 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors
  24. [24]

    Footitt J, Johnston SL. “Cough and viruses in airways disease: mechanisms.” Pulmonary pharmacology & therapeutics (2009). PMID: 19480062 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors
  25. [25]

    Black PN, McDonald CF. “Interventions to reduce the frequency of exacerbations of chronic obstructive pulmonary disease.” Postgraduate medical journal (2009). PMID: 19351641 ↗

    L5REVIEW_NARRATIVECited in: Etiology and Triggering Factors
  26. [26]

    Chen CYJ, Yew MS, Abisheganaden JA et al.. “Predictors of Influenza PCR Positivity in Acute Exacerbations of Chronic Obstructive Pulmonary Disease.” International journal of chronic obstructive pulmonary disease (2022). PMID: 35023911 ↗

    L5OTHERCited in: Etiology and Triggering Factors, Diagnosis and Workup
  27. [27]

    Oliveira A, Quach S, Alsubheen S et al.. “Rapid access rehabilitation after exacerbations of COPD - A qualitative study.” Respiratory medicine (2021). PMID: 34260976 ↗

    L5OTHERCited in: Etiology and Triggering Factors, Diagnosis and Workup, Prognosis and Long-term Outcomes
  28. [28]

    Schneider CV, Strnad P. “SARS-CoV-2 infection in alpha1-antitrypsin deficiency.” Respiratory medicine (2021). PMID: 34010739 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  29. [29]

    Jang JG, Ahn JH, Jin HJ. “Incidence and Prognostic Factors of Respiratory Viral Infections in Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease.” International journal of chronic obstructive pulmonary disease (2021). PMID: 33994783 ↗

    L5OTHERCited in: Etiology and Triggering Factors, Diagnosis and Workup, Prognosis and Long-term Outcomes
  30. [30]

    Nolen LD, Seeman S, Desnoyers C et al.. “Respiratory syncytial virus and influenza hospitalizations in Alaska native adults.” Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology (2020). PMID: 32334281 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  31. [31]

    Dauchy C, Bautin N, Nseir S et al.. “Emergence of Aspergillus fumigatus azole resistance in azole-naïve patients with chronic obstructive pulmonary disease and their homes.” Indoor air (2018). PMID: 29082624 ↗

    L5OTHERCited in: Etiology and Triggering Factors
  32. [32]

    Jabbour S, Fouhey D, Shepard S et al.. “Measuring the Impact of AI in the Diagnosis of Hospitalized Patients: A Randomized Clinical Vignette Survey Study.” JAMA (2023). PMID: 38112814 ↗

    L1bRCTCited in: Diagnosis and Workup, Differential Diagnosis
  33. [33]

    Galindo-Filho VC, Alcoforado L, Rattes C et al.. “A mesh nebulizer is more effective than jet nebulizer to nebulize bronchodilators during non-invasive ventilation of subjects with COPD: A randomized controlled trial with radiolabeled aerosols.” Respiratory medicine (2019). PMID: 31170543 ↗

    L1bRCTCited in: Diagnosis and Workup, Management: Pharmacological Therapy, Management: Respiratory Support
  34. [34]

    Furian M, Lichtblau M, Aeschbacher SS et al.. “Efficacy of Dexamethasone in Preventing Acute Mountain Sickness in COPD Patients: Randomized Trial.” Chest (2018). PMID: 29909285 ↗

    L1bRCTCited in: Diagnosis and Workup, Management: Pharmacological Therapy, Prognosis and Long-term Outcomes
  35. [35]

    Daubin C, Valette X, Thiollière F et al.. “Procalcitonin algorithm to guide initial antibiotic therapy in acute exacerbations of COPD admitted to the ICU: a randomized multicenter study.” Intensive care medicine (2018). PMID: 29663044 ↗

    L1bRCTCited in: Diagnosis and Workup, Management: Pharmacological Therapy
  36. [36]

    Jaeger D, Duchanois C, Duarte K et al.. “Performance of an ultrasound diagnostic algorithm for acute dyspneic patients in the emergency department: an EMERALD-US protocol.” BMJ open (2025). PMID: 40784781 ↗

    L2bTRIAL_NONRANDOMCited in: Diagnosis and Workup, Differential Diagnosis
  37. [37]

    Jin J, Zhang H, Li D et al.. “Effectiveness of Xin Jia Xuan Bai Cheng Qi Decoction in treating acute exacerbation of chronic obstructive pulmonary disease: study protocol for a multicentre, randomised, controlled trial.” BMJ open (2019). PMID: 31784433 ↗

    L2bTRIAL_NONRANDOMCited in: Diagnosis and Workup, Prognosis and Long-term Outcomes
  38. [38]

    Sehgal IS, Kalpakam H, Dhooria S et al.. “A Randomized Controlled Trial of Noninvasive Ventilation with Pressure Support Ventilation and Adaptive Support Ventilation in Acute Exacerbation of COPD: A Feasibility Study.” COPD (2019). PMID: 31161812 ↗

    L1bRCTCited in: Diagnosis and Workup, Management: Respiratory Support, Prognosis and Long-term Outcomes
  39. [39]

    Li L, Wang L, Zhang L et al.. “Frailty and in-hospital mortality in older patients with acute exacerbation of COPD: A real-world prospective cohort study.” Respiratory medicine (2024). PMID: 38763445 ↗

    L2bCOHORTCited in: Diagnosis and Workup, Prognosis and Long-term Outcomes
  40. [40]

    Cortegiani A, Longhini F, Carlucci A et al.. “High-flow nasal therapy versus noninvasive ventilation in COPD patients with mild-to-moderate hypercapnic acute respiratory failure: study protocol for a noninferiority randomized clinical trial.” Trials (2019). PMID: 31331372 ↗

    L2bTRIAL_NONRANDOMCited in: Diagnosis and Workup, Management: Respiratory Support, Prognosis and Long-term Outcomes
  41. [41]

    Zhen G, Jing J, Fengsen L. “Traditional Chinese medicine classic herbal formula Xiaoqinglong decoction for acute exacerbation of chronic obstructive pulmonary disease: A systematic review protocol.” Medicine (2018). PMID: 30593152 ↗

    L2aSR_OBSCited in: Diagnosis and Workup, Prognosis and Long-term Outcomes
  42. [42]

    Hu WP, Lhamo T, Zhang FY et al.. “Predictors of acute cardiovascular events following acute exacerbation period for patients with COPD: a nested case-control study.” BMC cardiovascular disorders (2020). PMID: 33302869 ↗

    L3bCASE_CONTROLCited in: Diagnosis and Workup, Prognosis and Long-term Outcomes
  43. [43]

    Gloeckl R, Jones PW, Kroll D et al.. “Can Patient Education Lead the Way? Head-To-Head Comparison of EXACT and CERT for Early Recognition of Acute COPD Exacerbations.” Respirology (Carlton, Vic.) (2026). PMID: 41320645 ↗

    L5OTHERCited in: Diagnosis and Workup
  44. [44]

    Pillai S, Lawrence M, Zaldua JC et al.. “Alterations in clot microstructure in acute exacerbations of COPD.” Respiratory research (2025). PMID: 41254616 ↗

    L5OTHERCited in: Diagnosis and Workup
  45. [45]

    Hamza Yousef MS, Al Azizi HM, Fouad MM. “Point of care ultrasound as a bedside diagnostic tool in acute dyspnea patients in emergency department for timely management.” Respiratory medicine (2025). PMID: 41237919 ↗

    L5OTHERCited in: Diagnosis and Workup, Differential Diagnosis
  46. [46]

    Welch C, Bravo L, Gkoutos G et al.. “Establishing Predictors of Acute Sarcopenia: A Proof-Of-Concept Study Utilising Network Analysis.” Aging and disease (2024). PMID: 39012665 ↗

    L5OTHERCited in: Diagnosis and Workup
  47. [47]

    Echevarria C, Steer J, Prasad A et al.. “Admission blood eosinophil count, inpatient death and death at 1 year in exacerbating patients with COPD.” Thorax (2023). PMID: 37487711 ↗

    L5OTHERCited in: Diagnosis and Workup, Management: Pharmacological Therapy
  48. [48]

    Zhang Y, Ren L, Sun J et al.. “Increased Serum Soluble Interleukin-2 Receptor Associated with Severity of Acute Exacerbation of Chronic Obstructive Pulmonary Disease.” International journal of chronic obstructive pulmonary disease (2021). PMID: 34522094 ↗

    L5OTHERCited in: Diagnosis and Workup, Prognosis and Long-term Outcomes
  49. [49]

    Peng L, Han L, Li XN et al.. “The Predictive Value of microRNA-134 and microRNA-1233 for the Early Diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Pulmonary Embolism.” International journal of chronic obstructive pulmonary disease (2020). PMID: 33116466 ↗

    L5OTHERCited in: Diagnosis and Workup, Differential Diagnosis
  50. [50]

    Karege G, Zekry D, Allali G et al.. “Gait speed is associated with death or readmission among patients surviving acute hypercapnic respiratory failure.” BMJ open respiratory research (2020). PMID: 32561512 ↗

    L5OTHERCited in: Diagnosis and Workup, Management: Respiratory Support, Prognosis and Long-term Outcomes
  51. [51]

    Miró Ò, Takagi K, Gayat E et al.. “CORT-AHF Study: Effect on Outcomes of Systemic Corticosteroid Therapy During Early Management Acute Heart Failure.” JACC. Heart failure (2019). PMID: 31521676 ↗

    L5OTHERCited in: Diagnosis and Workup, Management: Pharmacological Therapy, Prognosis and Long-term Outcomes
  52. [52]

    Pulido Herrero E, García Gutiérrez S, Antón Ladislao A et al.. “Chronic obstructive pulmonary disease assessment test: usefulness for monitoring recovery and predicting poor course of disease after exacerbations.” Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias (2019). PMID: 30656869 ↗

    L2bTRIAL_NONRANDOMCited in: Diagnosis and Workup, Prognosis and Long-term Outcomes
  53. [53]

    Suzuki S, Yoshihisa A, Sato Y et al.. “Clinical Significance of Get With the Guidelines-Heart Failure Risk Score in Patients With Chronic Heart Failure After Hospitalization.” Journal of the American Heart Association (2018). PMID: 30371158 ↗

    L5OTHERCited in: Diagnosis and Workup
  54. [54]

    Ladjemi MZ, Martin C, Lecocq M et al.. “Increased IgA Expression in Lung Lymphoid Follicles in Severe Chronic Obstructive Pulmonary Disease.” American journal of respiratory and critical care medicine (2019). PMID: 30339768 ↗

    L5OTHERCited in: Diagnosis and Workup
  55. [55]

    Labaki WW, Xia M, Murray S et al.. “NT-proBNP in stable COPD and future exacerbation risk: Analysis of the SPIROMICS cohort.” Respiratory medicine (2018). PMID: 29957287 ↗

    L5OTHERCited in: Diagnosis and Workup
  56. [56]

    Oliveira A, Rodrigues J, Marques A. “Enhancing our understanding of computerised adventitious respiratory sounds in different COPD phases and healthy people.” Respiratory medicine (2018). PMID: 29724394 ↗

    L5OTHERCited in: Diagnosis and Workup
  57. [57]

    Aleva FE, Voets LWLM, Simons SO et al.. “Prevalence and Localization of Pulmonary Embolism in Unexplained Acute Exacerbations of COPD: A Systematic Review and Meta-analysis.” Chest (2017). PMID: 27522956 ↗

    L2aSR_OBSCited in: Differential Diagnosis
  58. [58]

    Domínguez-Rodríguez A, Hernandez-Vaquero D, Suero-Mendez C et al.. “Effects of MIdazolam versus MOrphine in acute cardiogenic pulmonary edema and chronic obstructive pulmonary disease: An analysis of MIMO trial.” The American journal of emergency medicine (2023). PMID: 37703629 ↗

    L1bRCTCited in: Differential Diagnosis
  59. [59]

    Deutz NE, Matheson EM, Matarese LE et al.. “Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial.” Clinical nutrition (Edinburgh, Scotland) (2016). PMID: 26797412 ↗

    L1bRCTCited in: Differential Diagnosis, Management: Pharmacological Therapy
  60. [60]

    Prosen G, Klemen P, Štrnad M et al.. “Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting.” Critical care (London, England) (2011). PMID: 21492424 ↗

    L2bTRIAL_NONRANDOMCited in: Differential Diagnosis
  61. [61]

    Gulea C, Zakeri R, Quint JK. “Impact of chronic obstructive pulmonary disease on readmission after hospitalization for acute heart failure: A nationally representative US cohort study.” International journal of cardiology (2019). PMID: 31101544 ↗

    L2bCOHORTCited in: Differential Diagnosis, Prognosis and Long-term Outcomes
  62. [62]

    Cao YQ, Dong LX, Cao J. “Pulmonary Embolism in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.” Chinese medical journal (2018). PMID: 29998894 ↗

    L5REVIEW_NARRATIVECited in: Differential Diagnosis
  63. [63]

    Neesse A, Jerrentrup A, Hoffmann S et al.. “Prehospital chest emergency sonography trial in Germany: a prospective study.” European journal of emergency medicine : official journal of the European Society for Emergency Medicine (2012). PMID: 21817908 ↗

    L2bCOHORTCited in: Differential Diagnosis
  64. [64]

    Fu X, Zhong Y, Xu W et al.. “The prevalence and clinical features of pulmonary embolism in patients with AE-COPD: A meta-analysis and systematic review.” PloS one (2021). PMID: 34473738 ↗

    L2aSR_OBSCited in: Differential Diagnosis
  65. [65]

    Ege MR, Guray U, Guray Y et al.. “Acute heart failure with accompanying chronic obstructive pulmonary disease: should we focus on beta blockers?” Herz (2012). PMID: 22699995 ↗

    L2bTRIAL_NONRANDOMCited in: Differential Diagnosis
  66. [66]

    Nakamura K, Alba GA, Scheske JA et al.. “A 57-Year-Old Man With Insidious Dyspnea and Nonpleuritic Chest and Back Pain.” Chest (2016). PMID: 27502992 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  67. [67]

    Mantuani D, Nagdev A. “Three-view bedside ultrasound to differentiate acute decompensated heart failure from chronic obstructive pulmonary disease.” The American journal of emergency medicine (2013). PMID: 23380088 ↗

    L4CASE_REPORTCited in: Differential Diagnosis
  68. [68]

    Bertoletti L, Couturaud F, Sanchez O et al.. “Pulmonary Embolism and Chronic Obstructive Pulmonary Disease.” Seminars in thrombosis and hemostasis (2023). PMID: 36108648 ↗

    L5REVIEW_NARRATIVECited in: Differential Diagnosis
  69. [69]

    Hüfner A, Dodt C. “[Ermergency diagnostics and therapeutic management of acute dyspnea].” Medizinische Klinik, Intensivmedizin und Notfallmedizin (2015). PMID: 26407960 ↗

    L5REVIEW_NARRATIVECited in: Differential Diagnosis
  70. [70]

    Hüfner A, Dodt C. “[Definition, primary examination and differential diagnostics in acute dyspnea].” Medizinische Klinik, Intensivmedizin und Notfallmedizin (2015). PMID: 26335293 ↗

    L5REVIEW_NARRATIVECited in: Differential Diagnosis
  71. [71]

    Farmakis IT, Valerio L, Barco S et al.. “Functional capacity and dyspnea during follow-up after acute pulmonary embolism.” Journal of thrombosis and haemostasis : JTH (2024). PMID: 37652350 ↗

    L5OTHERCited in: Differential Diagnosis
  72. [72]

    Cerullo M, Yang K, Joynt Maddox KE et al.. “Association Between Hospital Private Equity Acquisition and Outcomes of Acute Medical Conditions Among Medicare Beneficiaries.” JAMA network open (2022). PMID: 35486398 ↗

    L5OTHERCited in: Differential Diagnosis
  73. [73]

    Beltaief K, Msolli MA, Zorgati A et al.. “Nebulized Terbutaline and Ipratropium Bromide Versus Terbutaline Alone in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Requiring Noninvasive Ventilation: A Randomized Double-blind Controlled Trial.” Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (2019). PMID: 30156361 ↗

    L1bRCTCited in: Management: Pharmacological Therapy
  74. [74]

    Ding Z, Li X, Lu Y et al.. “A randomized, controlled multicentric study of inhaled budesonide and intravenous methylprednisolone in the treatment on acute exacerbation of chronic obstructive pulmonary disease.” Respiratory medicine (2016). PMID: 27888990 ↗

    L1bRCTCited in: Management: Pharmacological Therapy
  75. [75]

    Wang JX, Zhang SM, Li XH et al.. “Acute exacerbations of chronic obstructive pulmonary disease with low serum procalcitonin values do not benefit from antibiotic treatment: a prospective randomized controlled trial.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2016). PMID: 27155210 ↗

    L1bRCTCited in: Management: Pharmacological Therapy
  76. [76]

    Gold DR, Litonjua AA, Carey VJ et al.. “Lung VITAL: Rationale, design, and baseline characteristics of an ancillary study evaluating the effects of vitamin D and/or marine omega-3 fatty acid supplements on acute exacerbations of chronic respiratory disease, asthma control, pneumonia and lung function in adults.” Contemporary clinical trials (2016). PMID: 26784651 ↗

    L1bRCTCited in: Management: Pharmacological Therapy
  77. [77]

    Geiger-Brown J, Lindberg S, Krachman S et al.. “Self-reported sleep quality and acute exacerbations of chronic obstructive pulmonary disease.” International journal of chronic obstructive pulmonary disease (2015). PMID: 25759571 ↗

    L1bRCTCited in: Management: Pharmacological Therapy
  78. [78]

    Rabe KF, Fabbri LM, Israel E et al.. “Effect of ADRB2 polymorphisms on the efficacy of salmeterol and tiotropium in preventing COPD exacerbations: a prespecified substudy of the POET-COPD trial.” The Lancet. Respiratory medicine (2014). PMID: 24461901 ↗

    L1bRCTCited in: Management: Pharmacological Therapy
  79. [79]

    Rogliani P, Ora J, Ciaprini C et al.. “Effect of indacaterol on arterial blood gases in patients suffering from acute exacerbation of COPD.” Respiratory medicine (2014). PMID: 24238769 ↗

    L1bRCTCited in: Management: Pharmacological Therapy
  80. [80]

    Anzueto A, Niewoehner DE, Leimer I et al.. “A post hoc pooled analysis of exacerbations among US participants in randomized controlled trials of tiotropium.” Respiratory medicine (2013). PMID: 23969305 ↗

    L1bRCTCited in: Management: Pharmacological Therapy
  81. [81]

    Leuppi JD, Schuetz P, Bingisser R et al.. “Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial.” JAMA (2013). PMID: 23695200 ↗

    L1bRCTCited in: Management: Pharmacological Therapy
  82. [82]

    Torres-Sánchez I, Valenza MC, Cabrera-Martos I et al.. “Effects of an Exercise Intervention in Frail Older Patients with Chronic Obstructive Pulmonary Disease Hospitalized due to an Exacerbation: A Randomized Controlled Trial.” COPD (2017). PMID: 27715322 ↗

    L1bRCTCited in: Management: Pharmacological Therapy, Management: Respiratory Support
  83. [83]

    Rohde GG, Koch A, Welte T. “Randomized double blind placebo-controlled study to demonstrate that antibiotics are not needed in moderate acute exacerbations of COPD--the ABACOPD study.” BMC pulmonary medicine (2015). PMID: 25623589 ↗

    L1bRCTCited in: Management: Pharmacological Therapy, Management: Respiratory Support
  84. [84]

    Segreti A, Fiori E, Calzetta L et al.. “The effect of indacaterol during an acute exacerbation of COPD.” Pulmonary pharmacology & therapeutics (2013). PMID: 23578980 ↗

    L1bRCTCited in: Management: Pharmacological Therapy
  85. [85]

    Postma DS, Anzueto AR, Jenkins C et al.. “Factor analysis in predominantly severe COPD: identification of disease heterogeneity by easily measurable characteristics.” Respiratory medicine (2013). PMID: 23953956 ↗

    L2aSR_OBSCited in: Management: Pharmacological Therapy
  86. [86]

    Vermeersch K, Gabrovska M, Deslypere G et al.. “The Belgian trial with azithromycin for acute COPD exacerbations requiring hospitalization: an investigator-initiated study protocol for a multicenter, randomized, double-blind, placebo-controlled trial.” International journal of chronic obstructive pulmonary disease (2016). PMID: 27099485 ↗

    L5OTHERCited in: Management: Pharmacological Therapy
  87. [87]

    Lopardo G, Pensotti C, Scapellato P et al.. “[Inter-society consensus for the management of respiratory infections: acute bronchitis and chronic obstructive pulmonary disease].” Medicina (2013). PMID: 23570768 ↗

    L1cGUIDELINECited in: Management: Pharmacological Therapy, Guidelines and Resources
  88. [88]

    Yang L, Li M, Shu J et al.. “A Risk Prediction Model for Prolonged Length of Stay in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Retrospective Study of 225 Patients in a Single Center in Kunming, China.” Medical science monitor : international medical journal of experimental and clinical research (2022). PMID: 35136009 ↗

    L2bCOHORTCited in: Management: Pharmacological Therapy
  89. [89]

    Walters JA, Tan DJ, White CJ et al.. “Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease.” The Cochrane database of systematic reviews (2014). PMID: 25178099 ↗

    L2aSR_OBSCited in: Management: Pharmacological Therapy
  90. [90]

    Whittaker Brown SA, Braman S. “Recent Advances in the Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease.” The Medical clinics of North America (2020). PMID: 32505256 ↗

    L5REVIEW_NARRATIVECited in: Management: Pharmacological Therapy, Management: Respiratory Support
  91. [91]

    Komagamine J. “Prevalence of potentially inappropriate medications at admission and discharge among hospitalised elderly patients with acute medical illness at a single centre in Japan: a retrospective cross-sectional study.” BMJ open (2018). PMID: 30030316 ↗

    L5OTHERCited in: Management: Pharmacological Therapy
  92. [92]

    Naderi N, Assayag D, Mostafavi-Pour-Manshadi SM et al.. “Long-term azithromycin therapy to reduce acute exacerbations in patients with severe chronic obstructive pulmonary disease.” Respiratory medicine (2018). PMID: 29724384 ↗

    L5OTHERCited in: Management: Pharmacological Therapy
  93. [93]

    Su VY, Yang KY, Yang YH et al.. “Use of ICS/LABA Combinations or LAMA Is Associated with a Lower Risk of Acute Exacerbation in Patients with Coexistent COPD and Asthma.” The journal of allergy and clinical immunology. In practice (2018). PMID: 29432960 ↗

    L5OTHERCited in: Management: Pharmacological Therapy
  94. [94]

    Kelly AM, Holdgate A, Keijzers G et al.. “Epidemiology, treatment, disposition and outcome of patients with acute exacerbation of COPD presenting to emergency departments in Australia and South East Asia: An AANZDEM study.” Respirology (Carlton, Vic.) (2018). PMID: 29394524 ↗

    L5OTHERCited in: Management: Pharmacological Therapy, Management: Respiratory Support
  95. [95]

    Ergan B, Ergün R. “Impact of anemia on short-term survival in severe COPD exacerbations: a cohort study.” International journal of chronic obstructive pulmonary disease (2016). PMID: 27536089 ↗

    L2bCOHORTCited in: Management: Respiratory Support
  96. [96]

    Corrêa TD, Sanches PR, de Morais LC et al.. “Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study.” BMC pulmonary medicine (2015). PMID: 26559350 ↗

    L2bCOHORTCited in: Management: Respiratory Support
  97. [97]

    Jayadev A, Stone R, Steiner MC et al.. “Time to NIV and mortality in AECOPD hospital admissions: an observational study into real world insights from National COPD Audits.” BMJ open respiratory research (2019). PMID: 31423314 ↗

    L5OTHERCited in: Management: Respiratory Support
  98. [98]

    Comellini V, Pacilli AMG, Nava S. “Benefits of non-invasive ventilation in acute hypercapnic respiratory failure.” Respirology (Carlton, Vic.) (2019). PMID: 30636373 ↗

    L5REVIEW_NARRATIVECited in: Management: Respiratory Support
  99. [99]

    Miró Ò, Martínez G, Masip J et al.. “Effects on short term outcome of non-invasive ventilation use in the emergency department to treat patients with acute heart failure: A propensity score-based analysis of the EAHFE Registry.” European journal of internal medicine (2018). PMID: 29572091 ↗

    L5OTHERCited in: Management: Respiratory Support
  100. [100]

    Parker K, Perikala V, Aminazad A et al.. “Models of care for non-invasive ventilation in the Acute COPD Comparison of three Tertiary hospitals (ACT3) study.” Respirology (Carlton, Vic.) (2018). PMID: 29224257 ↗

    L5OTHERCited in: Management: Respiratory Support
  101. [101]

    Poon T, Paris DG, Aitken SL et al.. “Extended Versus Short-Course Corticosteroid Taper Regimens in the Management of Chronic Obstructive Pulmonary Disease Exacerbations in Critically Ill Patients.” Journal of intensive care medicine (2020). PMID: 29161935 ↗

    L5OTHERCited in: Management: Respiratory Support
  102. [102]

    Lemyze M, Bury Q, Guiot A et al.. “Delayed but successful response to noninvasive ventilation in COPD patients with acute hypercapnic respiratory failure.” International journal of chronic obstructive pulmonary disease (2017). PMID: 28579772 ↗

    L5OTHERCited in: Management: Respiratory Support
  103. [103]

    Song Y, Chen R, Zhan Q et al.. “The optimum timing to wean invasive ventilation for patients with AECOPD or COPD with pulmonary infection.” International journal of chronic obstructive pulmonary disease (2016). PMID: 27042042 ↗

    L5REVIEW_NARRATIVECited in: Management: Respiratory Support
  104. [104]

    Pisani L, Corcione N, Nava S. “Management of acute hypercapnic respiratory failure.” Current opinion in critical care (2016). PMID: 26627537 ↗

    L5REVIEW_NARRATIVECited in: Management: Respiratory Support
  105. [105]

    Fan L, Zhao Q, Liu Y et al.. “Semiquantitative cough strength score and associated outcomes in noninvasive positive pressure ventilation patients with acute exacerbation of chronic obstructive pulmonary disease.” Respiratory medicine (2014). PMID: 25459451 ↗

    L5OTHERCited in: Management: Respiratory Support
  106. [106]

    Brill SE, Wedzicha JA. “Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease.” International journal of chronic obstructive pulmonary disease (2014). PMID: 25404854 ↗

    L5REVIEW_NARRATIVECited in: Management: Respiratory Support
  107. [107]

    Ongel EA, Karakurt Z, Salturk C et al.. “How do COPD comorbidities affect ICU outcomes?” International journal of chronic obstructive pulmonary disease (2014). PMID: 25378919 ↗

    L5OTHERCited in: Management: Respiratory Support
  108. [108]

    Lindenauer PK, Stefan MS, Shieh MS et al.. “Outcomes associated with invasive and noninvasive ventilation among patients hospitalized with exacerbations of chronic obstructive pulmonary disease.” JAMA internal medicine (2014). PMID: 25347545 ↗

    L5OTHERCited in: Management: Respiratory Support
  109. [109]

    Park MJ, Rhee CK, Kim YH et al.. “Efficacy and safety of HL301 in the treatment of acute bronchitis and acute exacerbation of chronic bronchitis: a phase 2, randomized, double-blind, placebo-controlled, multicenter study.” Current medical research and opinion (2017). PMID: 28277874 ↗

    L1bRCTCited in: Prognosis and Long-term Outcomes
  110. [110]

    Mir T, Uddin M, Khalil A et al.. “Mortality outcomes associated with invasive aspergillosis among acute exacerbation of chronic obstructive pulmonary disease patient population.” Respiratory medicine (2022). PMID: 34959147 ↗

    L5OTHERCited in: Prognosis and Long-term Outcomes
  111. [111]

    Hoffman GJ, Yakusheva O. “Association Between Financial Incentives in Medicare's Hospital Readmissions Reduction Program and Hospital Readmission Performance.” JAMA network open (2020). PMID: 32242906 ↗

    L5OTHERCited in: Prognosis and Long-term Outcomes
  112. [112]

    Spannella F, Giulietti F, Cocci G et al.. “Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Oldest Adults: Predictors of In-Hospital Mortality and Need for Post-acute Care.” Journal of the American Medical Directors Association (2019). PMID: 30826270 ↗

    L5OTHERCited in: Prognosis and Long-term Outcomes
  113. [113]

    Chen W, Qing-yuan Z. “[Guideline for mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (2007)].” Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue (2007). PMID: 17767816 ↗

    L1cGUIDELINECited in: Guidelines and Resources

Revision History

All updates applied to this page

Loading revisions…