Clinical history, physical findings and diagnostic procedures in patients with exacerbation of chronic obstructive pulmonary disease (COPD)
| Level I | Level II | Level III | |
| Clinical history | |||
| Co-morbid conditions# | + | +++ | +++ |
| History of frequent exacerbations | + | +++ | +++ |
| Severity of COPD | Mild/moderate | Moderate/severe | Severe |
| Physical findings | |||
| Haemodynamic evaluation | Stable | Stable | Stable/unstable |
| Use accessory respiratory muscles, tachypnoea | Not present | ++ | +++ |
| Persistent symptoms after initial therapy | No | ++ | +++ |
| Diagnostic procedures | |||
| Oxygen saturation | Yes | Yes | Yes |
| Arterial blood gases | No | Yes | Yes |
| Chest radiograph | No | Yes | Yes |
| Blood tests¶ | No | Yes | Yes |
| Serum drug concentrations+ | If applicable | If applicable | If applicable |
| Sputum gram stain and culture | No§ | Yes | Yes |
| Electrocardiogram | No | Yes | Yes |
+: 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