Worth H
Medizinische Klinik I, Klinikum Fürth.
MMW Fortschr Med. 2006 Jan 12;148(1-2):28-31.
Exacerbations in COPD patients are characterized by an acute aggravation of the condition with an increase in symptoms (labored breathing, cough, expectoration, tightness of the chest and, rarely, fever). The major cause is a bronchial infection. The medications of choice are inhalative bronchodilators, in particular beta-2 sympathomimetics and/or anticholinergic agents, together with systemic glucocorticosteroids, and also theophylline. COPD patients experiencing exacerbations and showing clinical signs of bacterial airway infection can benefit from antibiotic treatment. In the presence of an acute partial respiratory insufficiency, administration of oxygen is indicated, while respiratory insufficiency with hypercapnea and acidosis necessitates the use of noninvasive positive pressure ventilation. For the prevention of acute exacerbations, risk factors must be eliminated, in particular cigarette smoking. Furthermore, optimized management including structured patient education is to be recommended.
慢性阻塞性肺疾病（COPD）患者的病情加重表现为病情急性恶化，症状增加（呼吸费力、咳嗽、咳痰、胸闷，很少有发热）。主要原因是支气管感染。首选药物是吸入性支气管扩张剂，特别是β-2肾上腺素能受体激动剂和/或抗胆碱能药物，同时使用全身性糖皮质激素，还有茶碱。病情加重且有细菌气道感染临床体征的COPD患者可从抗生素治疗中获益。在存在急性部分呼吸功能不全时，需给予吸氧，而伴有高碳酸血症和酸中毒的呼吸功能不全则需要使用无创正压通气。为预防急性加重，必须消除危险因素，尤其是吸烟。此外，建议进行优化管理，包括对患者进行结构化教育。
