title: [Management of COPD exacerbations: from primary care to hospitalization].
abstract: The Société de pneumologie de langue française defines acute exacerbation of chronic obstructive pulmonary disease (AE COPD) as an increase in daily respiratory symptoms, basically duration ≥ 48h or need for treatment adjustment. Etiology of EA COPD are mainly infectious, viral (rhinovirus, influenzae or parainfluenzae virus, coronavirus, adenovirus and respiratory syncytial virus) or bacterial (Haemophilus influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis). Pollutant exposure can also lead to AE COPD, such as NO2, SO2, ozone or particulates (PM10 and PM2.5). In 30% the etiology remains unknown. Differential diagnoses of AE COPD include infectious pneumonia, pneumothorax, acute heart failure and pulmonary embolism. Presences of signs of severity impose hospitalization: signs of respiratory distress, shock, acute confusion but also fragile patients, insufficient home support or absence of response to initial treatment. AE COPD treatments consist on increase in bronchodilators, chest physiotherapy, and antibiotics if sputum is frankly purulent. Systemic corticosteroids should not be systematic. Recommended dose is 0.5 mg/kg on short course (5-7 days). During hospitalization, oxygen supplementation and thromboprophylaxis could be prescribed. The main interest in non-invasive ventilation is persistent hypercapnia despite optimal medical management. During ambulatory management or hospitalization, clinical assessment at 48-72 h is mandatory.
authors.affiliation: Hôpital Pontchaillou, université de Rennes 1, service de pneumologie, 35033 Rennes, France; IRSET UMR 1085, université de Rennes 1, 35065 Rennes, France. Electronic address: Stephane.JOUNEAU@chu-rennes.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Jouneau
authors.affiliation: Hôpital Pontchaillou, université de Rennes 1, service de pneumologie, 35033 Rennes, France.
authors.forename: Graziella
authors.initials: G
authors.lastname: Brinchault
authors.affiliation: Hôpital Pontchaillou, université de Rennes 1, service de pneumologie, 35033 Rennes, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Desrues
mesh_terms: D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018450:Disease Progression; D006760:Hospitalization; D006801:Humans; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*