Learning Objective #1: Describe an evidence-based approach to management of COPD exacerbation in primary care settings

Learning Objective #2: Differentiate when hospitalization/referral is needed for acute exacerbation of COPD with dyspnea

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Purpose: COPD affects 15% of adults over age 65 and deaths related to the disease continue to increase, especially in women (ALA, 1997). A majority of nurse practitioners (NPs) can expect to encounter patients with COPD; prevalence data show over 14 million cases of bronchitis, and 2 million of emphysema. Patients with COPD present approximately 3 times/yr with acute exacerbation and 3 to 16% need hospital admission/ readmission (Soto & Varkey, 2003); morbidity/mortality rates continue to rise. This presentation will provide APNs with an evidence-based approach to management of COPD exacerbation. COPD exacerbation is “sustained worsening of the patient's condition, from the stable state … that is acute in onset and necessitates a change in regular medication in a patient with underlying COPD” ( Rodriquez-Roisin, 2000). It is diagnosed by the presence of the following signs/symptoms: increased sputum purulence, increased sputum volume, and/or worsening dyspnea. History/physical examination provides critical information for deciding to treat in the community, refer or hospitalize. Pulse oximetry may be used in the office setting, but data from Chest X-Ray, ABGs and spirometry are often not available in primary care settings. The consensus of evidence that can be used to determine when hospitalization/ referral is needed for “acute exacerbation with dyspnea” will be presented. The presentation will include evidence for using (or not using) oxygen, bronchodilators, steroids, antibiotics, mucolytics (not), chest physiotherapy, and non-invasive ventilation, along with balancing concerns for individual patient treatment response with concerns relating to antibiotic resistance. The presentation will conclude with patient education and effective techniques to prevent future exacerbations. Summary: Hospitalizations may be prevented by recognizing COPD exacerbation, providing primary care treatment based on evidence, and identifying risk factors of low activity level, older age, and living alone that can indicate a need for home care and/or frequent office follow-up.