Để đặt lịch khám tại viện, Quý khách vui lòng bấm số hoặc đặt lịch trực tiếp . Tải và đặt lịch khám tự động trên ứng dụng MyVinmec để quản lý, theo dõi lịch và đặt hẹn mọi lúc mọi nơi ngay trên ứng dụng.
An acute exacerbation of chronic obstructive pulmonary disease, or acute exacerbations of chronic bronchitis [AECB], is a sudden worsening of chronic obstructive pulmonary disease [COPD] symptoms including shortness of breath, quantity and color of phlegm that typically lasts for several days.
It may be triggered by an infection with bacteria or viruses or by environmental pollutants. Typically, infections cause 75% or more of the exacerbations; bacteria can roughly be found in 25% of cases, viruses in another 25%, and both viruses and bacteria in another 25%. Airway inflammation is increased during the exacerbation resulting in increased hyperinflation, reduced expiratory air flow and decreased gas exchange.
Exacerbations can be classified as mild, moderate, and severe. As COPD progresses, exacerbations tend to become more frequent, the average being about three episodes per year.
Signs and symptoms[edit]
An acute exacerbation of COPD is associated with increased frequency and severity of coughing. It is often accompanied by worsened chest congestion and discomfort. Shortness of breath and wheezing are present in many cases. Exacerbations may be accompanied by increased amount of cough and sputum productions, and a change in appearance of sputum.[citation needed] An abrupt worsening in COPD symptoms may cause rupture of the airways in the lungs, which in turn may cause a spontaneous pneumothorax.
In infection, there is often weakness, fever and chills. If due to a bacterial infection, the sputum may be slightly streaked with blood and coloured yellow or green.
Causes[edit]
As the lungs tend to be vulnerable organs due to their exposure to harmful particles in the air, several things can cause an acute exacerbation of COPD:
- Respiratory infection, being responsible for approximately half of COPD exacerbations. Approximately half of these are due to viral infections and another half appears to be caused by bacterial infections. Common bacterial pathogens of acute exacerbations include Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Less common bacterial pathogens include Chlamydia pneumoniae and MRSA. Pathogens seen more frequently in patients with impaired lung function [FEV Guidelines for treatment of acute lung diseases. August 2004. Authors: Christer Hanson, Carl-Axel Karlsson, Mary Kämpe, Kristina Lamberg, Eva Lindberg, Lavinia Machado Boman, Gunnemar Stålenheim
- ^ "Acute exacerbations of chronic bronchitis [AECB]". The British Society for Antimicrobial Chemotherapy. Archived from the original on 2006-04-06.
- Geffen, Wouter H. van; Bruins, Marcel; Kerstjens, Huib A. M. [2016-01-01]. "Diagnosing viral and bacterial respiratory infections in acute COPD exacerbations by an electronic nose: a pilot study". Journal of Breath Research. 10 [3]: 036001. Bibcode:2016JBR....10c6001V. doi:10.1088/1752-7155/10/3/036001. ISSN 1752-7163. PMID 27310311.
- Makris D, Bouros D [January 2009]. "COPD Exacerbtion: Lost in Translation". BMC Pulm Med. 9 [6]: 6. doi:10.1186/1471-2466-9-6. PMC 2640343. PMID 19178701.
- Calverley PM, Anderson JA, Celli B, et al. [2007]. "Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease". N. Engl. J. Med. 356 [8]: 775–89. doi:10.1056/NEJMoa063070. PMID 17314337.
- Tashkin DP, Celli B, Senn S, et al. [October 2008]. "A 4-year trial of tiotropium in chronic obstructive pulmonary disease". The New England Journal of Medicine. 359 [15]: 1543–54. doi:10.1056/NEJMoa0805800. hdl:2437/111564. PMID 18836213.
- Zhou Y, Wang X, Zeng X, et al. [2006]. "Positive benefits of theophylline in a randomized, double-blind, parallel-group, placebo-controlled study of low-dose, slow-release theophylline in the treatment of COPD for 1 year". Respirology. 11 [5]: 603–10. doi:10.1111/j.1440-1843.2006.00897.x. PMID 16916334. S2CID 28582690.
- Burge PS, Calverley PM, Jones PW, Spencer S, Anderson JA, Maslen TK [2000]. "Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial". BMJ. 320 [7245]: 1297–303. doi:10.1136/bmj.320.7245.1297. PMC 27372. PMID 10807619.
- Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R [2010]. "Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial". BMJ. 341: c5462. doi:10.1136/bmj.c5462. PMC 2957540. PMID 20959284.
- Veenstra, Pieter; Veeger, Nic J. G. M.; Koppers, Ralph J. H.; Duiverman, Marieke L.; Geffen, Wouter H. van [2022-10-05]. "High-flow nasal cannula oxygen therapy for admitted COPD-patients. A retrospective cohort study". PLOS ONE. 17 [10]: e0272372. Bibcode:2022PLoSO..1772372V. doi:10.1371/journal.pone.0272372. ISSN 1932-6203. PMC 9534431. PMID 36197917.
- Dobler, CC; Morrow, AS; Beuschel, B; Farah, MH; Majzoub, AM; Wilson, ME; Hasan, B; Seisa, MO; Daraz, L; Prokop, LJ; Murad, MH; Wang, Z [17 March 2020]. "Pharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-analysis". Annals of Internal Medicine. 172 [6]: 413–422. doi:10.7326/M19-3007. PMID 32092762. S2CID 211476101.
- ^ Bach PB, Brown C, Gelfand SE, McCrory DC [2001]. "Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence". Ann. Intern. Med. 134 [7]: 600–20. doi:10.7326/0003-4819-134-7-200104030-00016. PMID 11281745. S2CID 35537845.
- van Geffen WH, Douma WR, Slebos DJ, Kerstjens HA [August 2016]. "Bronchodilators delivered by nebuliser versus pMDI with spacer or DPI for exacerbations of COPD". The Cochrane Database of Systematic Reviews. 2016 [8]: CD011826. doi:10.1002/14651858.CD011826.pub2. PMC 8487315. PMID 27569680.
- Walters, Julia Ae; Tan, Daniel J.; White, Clinton J.; Wood-Baker, Richard [19 March 2018]. "Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease". The Cochrane Database of Systematic Reviews. 2018 [3]: CD006897. doi:10.1002/14651858.CD006897.pub4. ISSN 1469-493X. PMC 6494402. PMID 29553157.
- Lindenauer PK, Pekow PS, Lahti MC, Lee Y, Benjamin EM, Rothberg MB [June 2010]. "Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease". JAMA. 303 [23]: 2359–67. doi:10.1001/jama.2010.796. PMID 20551406. Gibson, et al. Evidence-based Respiratory Medicine. Blackwell Publishing, 2005. ISBN 0-7279-1605-X. pp. 390–392.