presenting features of acute exacerbations

Last reviewed 01/2018

Exacerbations in patients may differ widely. Some patients may have mild episodes which are usually managed at home while some may face life-threatening events necessitating ventilatory support and a prolonged hospital stay (1) 

There is no single defining symptom of an exacerbation.

  • worsening of previous stable condition
  • increased wheeze
  • increased dyspnoea
  • increased sputum volume
  • increased sputum purulence
  • chest tightness
  • fluid retention
  • reduced exercise tolerance
  • increased fatigue (1)

Chest pain and fever are uncommon and if present should prompt a search for other aetiologies (1).

The following signs can be considered as signs of a severe exacerbation:

  • marked dyspnoea
  • tachypnoea
  • purse lip breathing
  • use of accessory muscles (sternomastoid and abdominal) at rest
  • acute confusion
  • new onset cyanosis
  • new onset peripheral oedema
  • marked reduction in activities of daily living (2)

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