Table 8

Clinical history, physical findings and diagnostic procedures in patients with exacerbation of chronic obstructive pulmonary disease (COPD)

Level ILevel IILevel III
Clinical history
 Co-morbid conditions#+++++++
 History of frequent exacerbations+++++++
 Severity of COPDMild/moderateModerate/severeSevere
Physical findings
 Haemodynamic evaluationStableStableStable/unstable
 Use accessory respiratory muscles, tachypnoeaNot present+++++
 Persistent symptoms after initial therapyNo+++++
Diagnostic procedures
 Oxygen saturationYesYesYes
 Arterial blood gasesNoYesYes
 Chest radiographNoYesYes
 Blood testsNoYesYes
 Serum drug concentrations+If applicableIf applicableIf applicable
 Sputum gram stain and cultureNo§YesYes
  • +: unlikely to be present

  • ++: likely to be present

  • +++: very likely to be present

  • #: the more common co-morbid conditions associated with poor prognosis in exacerbations are congestive heart failure, coronary artery disease, diabetes mellitus, renal and liver failure

  • : blood tests include cell blood count, serum electrolytes, renal and liver function

  • +: serum drug concentrations, consider if patients are using theophylline, warfarin, carbamezepine, digoxin

  • §: consider if patient has recently been on antibiotics