Exacerbations

NICE defines an exacerbation as a “sustained worsening of the patient’s symptoms from their usual stable state, which is beyond normal day-to-day variations, and is acute in onset”. Commonly reported symptoms are worsening breathlessness, cough, increased sputum production and a change in sputum colour. The change in these symptoms often necessitates a revision in medication and the use of a ‘rescue pack’. Points to reinforce the importance of using the pack include:  

• Recognising the start of an exacerbation such as whether there has been a change in the volume, purulence or colour of the phlegm they produce normally and whether they are experiencing a change in breathlessness or wheeze
• The risks and benefits of the treatment
• Alarm symptoms – things to be alert for that are not typically part of an exacerbation or signs that might mean something different is going on
• The need to contact their healthcare professional if they have started their rescue pack in order to alert them that they have become unwell.