Celli et al reported criteria to determine the severity of an exacerbation of chronic obstructive pulmonary disease (COPD). The authors are from multiple institutions in North America and Europe.
Parameters:
(1) dyspnea on a VAS scale from 0 to 10
(2) respiratory rate in breaths per minute
(3) heart rate in beats per minute
(4) resting arterial oxygen saturation on ambient air (or usual oxygen prescription) AND change from baseline in percent
(5) serum CRP in mg/L
(6) PaCO2 in mm Hg
(7) arterial pH
(8) PaO2 in mm Hg
If the PaCO2 > 45 mm Hg AND arterial pH < 7.35 then the exacerbation is severe.
Parameter
Finding
Points
dyspnea
< 5
0
>= 5
1
respiratory rate
< 24 breaths per minute
0
>= 24 breaths per minute
1
heart rate
< 95 beats per minute
0
>= 95 beats per minute
1
resting oxygen saturation
SaO2 >= 92% and change <= 3%
0
SaO2 < 92% and/or change > 3%
1
serum CRP
< 10 mg/L
0
>= 10 mg/L
1
score =
= SUM(points for all of the parameters)
If the score is >= 3 then the patient has at least a moderate exacerbation. A patient with a moderate exacerbation may have (PaO2 <= 60 mm Hg OR a PaCO2 > 45) AND pH >= 7.35.
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