TY - JOUR
T1 - Differential Diagnosis of Suspected Chronic Obstructive Pulmonary Disease Exacerbations in the Acute Care Setting Best Practice
AU - Celli, Bartolome R.
AU - Fabbri, Leonardo M.
AU - Aaron, Shawn D.
AU - Agusti, Alvar
AU - Brook, Robert D.
AU - Criner, Gerard J.
AU - Franssen, Frits M. E.
AU - Humbert, Marc
AU - Hurst, John R.
AU - de Oca, Maria Montes
AU - Pantoni, Leonardo
AU - Papi, Alberto
AU - Rodriguez-Roisin, Roberto
AU - Sethi, Sanjay
AU - Stolz, Daiana
AU - Torres, Antoni
AU - Vogelmeier, Claus F.
AU - Wedzicha, Jadwiga A.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Patients with chronic obstructive pulmonary disease (COPD) may suffer from acute episodes of worsening dyspnea, often associated with increased cough, sputum, and/or sputum purulence. These exacerbations of COPD (ECOPDs) impact health status, accelerate lung function decline, and increase the risk of hospitalization. Importantly, close to 20% of patients are readmitted within 30 days after hospital discharge, with great cost to the person and society. Approximately 25% and 65% of patients hospitalized for an ECOPD die within 1 and 5 years, respectively. Patients with COPD are usually older and frequently have concomitant chronic diseases, including heart failure, coronary artery disease, arrhythmias, interstitial lung diseases, bronchiectasis, asthma, anxiety, and depression, and are also at increased risk of developing pneumonia, pulmonary embolism, and pneumothorax. All of these morbidities not only increase the risk of subsequent ECOPDs but can also mimic or aggravate them. Importantly, close to 70% of readmissions after an ECOPD hospitalization result from decompensation of other morbidities. These observations suggest that in patients with COPD with worsening dyspnea but without the other classic characteristics of ECOPD, a careful search for these morbidities can help detect them and allow appropriate treatment. For most morbidities, a thorough clinical evaluation supplemented by appropriate clinical investigations can guide the healthcare provider to make a precise diagnosis. This perspective integrates the currently dispersed information available and provides a practical approach to patients with COPD complaining of worsening respiratory symptoms, particularly dyspnea. A systematic approach should help improve outcomes and the personal and societal cost of ECOPDs.
AB - Patients with chronic obstructive pulmonary disease (COPD) may suffer from acute episodes of worsening dyspnea, often associated with increased cough, sputum, and/or sputum purulence. These exacerbations of COPD (ECOPDs) impact health status, accelerate lung function decline, and increase the risk of hospitalization. Importantly, close to 20% of patients are readmitted within 30 days after hospital discharge, with great cost to the person and society. Approximately 25% and 65% of patients hospitalized for an ECOPD die within 1 and 5 years, respectively. Patients with COPD are usually older and frequently have concomitant chronic diseases, including heart failure, coronary artery disease, arrhythmias, interstitial lung diseases, bronchiectasis, asthma, anxiety, and depression, and are also at increased risk of developing pneumonia, pulmonary embolism, and pneumothorax. All of these morbidities not only increase the risk of subsequent ECOPDs but can also mimic or aggravate them. Importantly, close to 70% of readmissions after an ECOPD hospitalization result from decompensation of other morbidities. These observations suggest that in patients with COPD with worsening dyspnea but without the other classic characteristics of ECOPD, a careful search for these morbidities can help detect them and allow appropriate treatment. For most morbidities, a thorough clinical evaluation supplemented by appropriate clinical investigations can guide the healthcare provider to make a precise diagnosis. This perspective integrates the currently dispersed information available and provides a practical approach to patients with COPD complaining of worsening respiratory symptoms, particularly dyspnea. A systematic approach should help improve outcomes and the personal and societal cost of ECOPDs.
KW - COPD
KW - differential diagnosis
KW - symptom flare-up
KW - algorithms
KW - RESPIRATORY-TRACT INFECTIONS
KW - COMMUNITY-ACQUIRED PNEUMONIA
KW - MYOCARDIAL-INFARCTION
KW - CARDIOVASCULAR RISK
KW - ESC GUIDELINES
KW - ADULT PATIENTS
KW - ANTIBIOTIC USE
KW - ACUTE DYSPNEA
KW - MANAGEMENT
U2 - 10.1164/rccm.202209-1795CI
DO - 10.1164/rccm.202209-1795CI
M3 - (Systematic) Review article
C2 - 36701677
SN - 1073-449X
VL - 207
SP - 1134
EP - 1144
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 9
ER -