Assessment and Management of Patients with AECOPD

The following presents a brief summary of NICE and GOLD guidance in relation to managing AECOPD. For further information, we recommend that you read the full NICE +/- GOLD guidance documents.

Assessment (NICE)

Consider differential diagnosis:

  • Pneumonia
  • Pneumothorax
  • Left ventricular failure/pulmonary oedema
  • Pulmonary embolus
  • Lung cancer
  • Upper airway obstruction
  • Pleural effusion
  • Recurrent aspiration

Assessment of the severity of an exacerbation:
The following are signs of a severe exacerbation:

  • Marked dyspnoea
  • Tachypnea
  • 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

Consider the need for hospital admission:
Most patients can be managed at home.

The following suggest the need for hospitalisation:

  • Not able to cope at home
  • Severe breathlessness
  • Poor general condition
  • Poor level of activity
  • Cyanosis
  • Worsened peripheral oedema
  • Impaired consciousness / acute confusion
  • On long term oxygen therapy
  • Rapid onset
  • Significant comorbidity
  • SaO2 < 90%


NICE guidance - COPD June 2010.pdf NICE guidance - COPD June 2010.pdf
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GOLD_AtAGlance_2014_Jun11.pdf GOLD_AtAGlance_2014_Jun11.pdf
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Type : pdf


  • Sputum samples are not recommended in routine primary care practice.
  • Pulse oximetry is of value if there are clinical features of a severe exacerbation.