City and Hackney COPD acute exacerbation Urgent Care Pathway RR >24 /min, severe breathlessness Significant co-morbidities present e.g pneumonia, bronchiectasis, cardiac arrhythmias, congestive cardiac failure, diabetes mellitus, renal or liver failure Rapid rate of onset O2 sats<90% Acute confusion Deteriorating condition Previous need for non-invasive ventilation Previous exacerbations requiring ITU admission Uncertainty of diagnosis eg haemoptysis, weight loss, signs of pleural effusion, pneumothorax, heart failure Mild exacerbation – increased cough, sputum and mild increase in breathlessness RR <24 / min 02 Sats >90 - 92% Cyanosis absent Mental state unchanged and patient is fully alert No evidence of arrhythmia, pneumonia or heart failure Able to cope at home, eat and sleep, sufficient social support and adequate mobility If the patient is not responding differential diagnosis (see below) or refer to A&E REVIEW exacerbation and long term management of COPD in order to optimise treatment. Assess adherence with inhaler technique and review need for change, in preventer treatment Discuss Clinical presentation in a patient with known or suspected COPD History: worsening breathlessness, increased cough, increased sputum production or purulence or change in colour, upper airway symptoms, Other important points to consider in history: Number of previous exacerbations/hospitalisations, pre-existing co-morbidities, present treatment regime Authors: Hetal Dhruve, (Specialist Respiratory Pharmacist and joint Clinical Lead), Chandra Sarkar (GP Clinical Lead, Respiratory), Ben Molyneux (GP Clinical Lead, Unplanned Care) Date: July 2019 Review date: July 2022 Differential Diagnosis Pulmonary embolism Upper airway obstruction

City and Hackney COPD acute exacerbation Urgent Care Pathway · City and Hackney COPD acute exacerbation Urgent Care Pathway RR >24 /min, severe breathlessness Significant co-morbidities

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City and Hackney COPD acute exacerbation Urgent Care Pathway

RR >24 /min, severe breathlessness Significant co-morbidities present e.g pneumonia,

bronchiectasis, cardiac arrhythmias, congestive cardiac failure, diabetes mellitus, renal or liver failure

Rapid rate of onset O2 sats<90% Acute confusion Deteriorating condition

Previous need for non-invasive ventilation Previous exacerbations requiring ITU admission Uncertainty of diagnosis eg haemoptysis, weight

loss, signs of pleural effusion, pneumothorax, heart failure

Mild exacerbation – increased cough, sputum and mild increase in breathlessness

RR <24 / min 02 Sats >90 - 92% Cyanosis absent Mental state unchanged and patient is fully

alert No evidence of arrhythmia, pneumonia or

heart failure Able to cope at home, eat and sleep, sufficient

social support and adequate mobility

If the patient is not responding differential diagnosis (see

below) or refer to A&E

REVIEW

exacerbation and long term management of COPD in order to optimise treatment.

Assess adherence with inhaler technique and review need for change, in preventer treatment

Discuss

Clinical presentation in a patient with known or suspected COPDHistory: worsening breathlessness, increased cough, increased sputum production or purulence or change in colour, upper airway symptoms,

Other important points to consider in history: Number of previous exacerbations/hospitalisations, pre-existing co-morbidities, present treatment regime

Authors: Hetal Dhruve, (Specialist Respiratory Pharmacist and joint Clinical Lead), Chandra Sarkar (GP Clinical Lead, Respiratory), Ben Molyneux (GP Clinical Lead, Unplanned Care)Date: July 2019Review date: July 2022

Differential Diagnosis

Pulmonary embolism Upper airway obstruction