3 COPD Practice Questions

Recognizing an exacerbation

Increased shortness of breath, increased cough, or new or changed sputum, including yellow-green sputum, can indicate a COPD exacerbation. A patient should follow their individualized care or action plan and contact a clinician promptly. Severe symptoms require urgent help; these changes should not be dismissed or managed by independently stopping prescribed inhalers or increasing oxygen flow.

Oxygen during an acute exacerbation

Hypoxemia needs treatment. For a patient with an acute COPD exacerbation who is at risk of hypercapnic respiratory failure, oxygen should be given as prescribed and titrated to an appropriate target, with prompt reassessment of oxygenation and clinical status. Oxygen should not be withheld solely because the patient has COPD, nor should the highest available flow be applied and left unmonitored.

A commonly recommended initial oxygen saturation target for a patient at risk of hypercapnia is 88–92% while blood-gas results are pending. The target may be individualized based on blood gases, prior respiratory history, and clinical direction. Blood-gas evaluation may be indicated.

New or worsening drowsiness and confusion after oxygen is started may indicate worsening respiratory failure, including hypercapnia or hypoxemia. Promptly reassess and notify the appropriate clinician or rapid-response team; anticipate blood-gas evaluation and further respiratory support. Do not abruptly remove or stop oxygen: any adjustment should be made under clinical direction while the patient is evaluated.

Urgent warning signs and immediate support

New confusion or unusual drowsiness, severe breathlessness that makes speaking difficult, blue or gray lips or fingernails, and sudden worsening that does not improve with the prescribed rescue plan require urgent assessment and escalation. A stable, usual morning cough without a change in symptoms is not, by itself, an acute warning sign.

While assessing a breathless patient, position them upright and support their arms if comfortable. Coach slow exhalation through pursed-lip breathing, which can help some patients control breathlessness. These measures support, but do not replace, assessment and treatment of acute deterioration.

Using home oxygen safely

Patients should use home oxygen as prescribed and follow the equipment instructions. Feeling less short of breath is not a reason to independently turn down or stop prescribed oxygen, or to use it only when breathless if it was prescribed continuously. Oxygen needs can change, including after an exacerbation, so a clinician should reassess the prescription before changes are made.

Oxygen supports combustion. Keep it away from smoking, flames, and other ignition sources, and make sure household members know about the fire risk. Avoid petroleum-based products near oxygen equipment, and do not change the flow without clinical instructions.

Medicines and ongoing self-management

Use a prescribed short-acting bronchodilator for sudden symptoms according to the prescription. If severe symptoms persist or worsen, seek prompt medical help. A rescue inhaler does not replace maintenance treatment or an exacerbation action plan, and patients should not take extra doses beyond their prescription simply to make breathlessness disappear.

COPD management and exacerbation prevention can include teaching patients to recognize and report worsening symptoms early, supporting smoking cessation and avoidance of respiratory irritants, reviewing prescribed medicines and inhaler technique, and encouraging pulmonary rehabilitation when appropriate. Routine long-term bed rest can worsen deconditioning; activity should be individualized to the patient's capacity and care plan.

• controlled oxygen therapy