Overview of COPD exacerbations

An exacerbation of chronic obstructive pulmonary disease (COPD) is characterised by an acute worsening of symptoms, beyond normal day-to-day variations, including:

  • increased dyspnoea
  • reduced exercise tolerance
  • tachypnoea
  • increased cough frequency
  • increased sputum volume or purulence
  • fever
  • right heart failure, manifesting as ankle oedema.

Triggers for COPD exacerbations include viral and bacterial infections, as well as environmental pollutants, heart failure and pulmonary embolism. Exacerbations become more frequent as the severity of the patient’s stable COPD worsens.

COPD exacerbations can have similar presenting features to cardiovascular disease, which in both cases can include breathlessness, fatigue and chest discomfort.

Exacerbations are associated with increased morbidity, mortality and healthcare costs, and are a major source of avoidable hospitalisations in Australia. Following an exacerbation requiring hospitalisation, patients can experience a decline in quality of life and lung function, and are at risk of further serious exacerbations. Reducing exacerbations is therefore a primary goal of managing COPD.

COPD exacerbations are initially managed with inhaled bronchodilators. If symptoms do not resolve quickly with inhaled bronchodilator therapy, systemic corticosteroid therapy is recommended. Antibiotics are not routinely recommended for COPD exacerbations, but may be required for exacerbations associated with bacterial infection.

For severe exacerbations, oxygen therapy or noninvasive ventilatory support may be required.

All patients with COPD should have a written COPD action plan to follow during an exacerbation.

An admission to hospital for an exacerbation of COPD is a sentinel event that should trigger review of maintenance management, and consideration of advance care planning.

The Australian Commission on Safety and Quality in Health Care (ACSQHC) provides information to support best practice in the assessment and management of COPD (including exacerbations) in their Chronic Obstructive Pulmonary Disease Clinical Care Standard (2024).