Chronic obstructive pulmonary disease (COPD) exacerbation is an acute worsening of baseline respiratory symptoms in patients with underlying chronic lung disease. It is characterized by increased breathlessness, cough, sputum production, and reduced exercise tolerance. Because COPD patients often have limited respiratory reserve, even mild exacerbations can rapidly become life-threatening without prompt emergency intervention.

Exacerbations are commonly triggered by respiratory infections, air pollution, environmental irritants, or medication non-compliance. Inflammation leads to airway narrowing, mucus overproduction, and impaired gas exchange. Patients may present with increased wheezing, prolonged expiration, fatigue, cyanosis, or altered mental status in severe cases. Some individuals may also develop chest tightness or signs of respiratory distress.

Emergency evaluation begins with assessment of airway stability, oxygen saturation, and respiratory effort. Continuous pulse oximetry is initiated, and supplemental oxygen is carefully administered to maintain safe oxygen levels while avoiding carbon dioxide retention in susceptible patients. Respiratory rate, heart rate, and blood pressure are closely monitored.

Physical examination may reveal wheezing, diminished breath sounds, or signs of hyperinflation. Arterial blood gas testing may be performed in severe cases to assess oxygenation and carbon dioxide levels. Chest imaging may be obtained to rule out pneumonia, pneumothorax, or heart failure. Electrocardiography helps evaluate cardiac rhythm abnormalities, which are common in COPD patients.

Treatment focuses on bronchodilation and reduction of airway inflammation. Short-acting bronchodilators are administered via inhalation to improve airflow. Systemic anti-inflammatory therapy reduces airway swelling and decreases the duration of exacerbation. Antibiotics may be considered when bacterial infection is suspected. Non-invasive ventilatory support may be required in cases of respiratory failure to avoid intubation.

Frequent reassessment ensures that therapy is effective. Improvement in oxygen saturation, reduced work of breathing, and stabilization of vital signs indicate positive response. Lack of improvement prompts escalation of respiratory support and possible admission to higher levels of care.

COPD exacerbations significantly increase hospitalization risk and mortality if untreated. Rapid emergency evaluation, structured respiratory support, and targeted therapy reduce complications, improve survival, and help restore patients to their baseline respiratory function.