Patients with COPD commonly develop acute worsening of their disease, called Acute Exacerbations of COPD abbreviated as AECOPD. These episodes are clinically defined as a worsening of pulmonary symptoms – increased shortness of breath, increased sputum volume or purulence, increased wheezing, increased cough – that are beyond the normal day-to-day variation experienced by the patient. The definition also includes a need for increased health care such as systemic steroids and/or antibiotics prescribed by a health care provider either as an outpatient or during an emergency room visit or hospitalization. Exacerbations requiring hospital admission are termed severe exacerbations.
Some patients are at risk for “frequent” exacerbations, i.e., more than two exacerbations in a year. Frequent exacerbations may be associated with impaired quality of life and loss of lung function.
Patients should be counseled to report exacerbations promptly to thier physician or other health care providers so they may be treated appropriately. Health care providers may prescribe an oral steroid such as prednisone and/or an oral antibiotic for outpatients. In more severe cases, patients may be admitted to the hospital for more intensive therapy.
Reducing COPD exacerbations is a major goal of therapy. In order to determine those patients at the highest risk for AECOPD, a scoring system was developed by a team of international pulmonary physicians. [Make BJ, Eriksson GS, Calcerley PM, Jenkins C, Postma DS, Peterson S, Östlund O, Anzueto A. A score to predict short-term risk of COPD exacerbations (SCOPEX). International Journal of COPD 2014]
This scoring system, SCOPEX, was developed from the results of clinical trials that enrolled patients with COPD and a history of an exacerbation in the past year. These studies were six months in duration and thus the scoring system estimates the risk of developing an exacerbation in the subsequent six months. SCOPEX was designed to be used in routine clinical care and incorporates five clinical features that most clinicians have available during a visit with a patient with COPD.
In patients with COPD and a history of one or more exacerbations in the last year, select the appropriate responses below and the risk of an exacerbation in the next six months will be displayed.