| Mild exacerbation of COPD. Increased cough, sputum and mild increase in breathlessness. Patient is able to eat and sleep despite increase in symptoms | Increase in symptoms despite treatment. Patient unable to eat or sleep due to respiratory symptoms. New cyanosis or signs of cor pulmonale developing |
| Mental status unchanged; patient fully alert | Change in mental status |
| Respiratory rate <24/min | Respiratory rate ⩾24/min |
| Patients do not have arrhythmia, clinical signs of pneumonia or signs of heart failure | Signs of these are developing or other systemic disease such as hypotension reduced urine output |
| Signs suggestive of exacerbation of COPD in patients known to have COPD | Uncertainty of the diagnosis (eg, haemoptysis, weight loss, clinical signs of segmental collapse, pleural effusion or pneumothorax, symptoms suggestive of ischaemic heart disease or heart failure) |
| Exacerbations with preserved oxygen saturation (>92%) | Exacerbations requiring oxygen therapy; oxygen saturation ⩽92% in a patient not known to need long-term oxygen therapy |
| Patient requiring oral antibiotics | Patients not responding to oral antibiotics who might need intravenous antibiotics |
| Patient supported by family member | Lack of carer support (eg, hospitalisation of spouse or carers during COPD exacerbation) |
| Mobility regarded to be adequate | Impairment or increased impairment of mobility |