1 MD General Medicine, Junior Resident, School of Medical Sciences and Research, Sharda University. Email: singlad7@gmail.com
2 Professor, Department of General Medicine, School of Medical Sciences and Research, Sharda University.
3* Professor and Head, Head of Department of General Medicine, School of Medical Sciences and Research, Sharda University. Email: deepak.sharma4@sharda.ac.in (Corresponding Author)
4 MD General Medicine, Junior Resident, School of Medical Sciences and Research, Sharda University.
5 MD General Medicine, Junior Resident, School of Medical Sciences and Research, Sharda University.
6 MD General Medicine, Junior Resident.
Received: 20th Feb, 2026 | Revised: 4th Mar, 2026 | Accepted: 25th Mar, 2026 | Available Online: 10th Apr, 2026
Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of acute respiratory failure in elderly patients, often complicated by infection, hypoxemia, and hypercapnia. Early recognition and appropriate ventilatory support are crucial for favourable outcomes.
Introduction: Chronic obstructive pulmonary disease (COPD) is a common, preventable, and progressive respiratory disorder characterized by persistent airflow limitation and chronic airway inflammation. Acute exacerbations of COPD (AECOPD) are defined as episodes of worsening respiratory symptoms beyond normal day-to-day variation and are a major cause of hospitalization, morbidity, and mortality, particularly in elderly patients. Cardiovascular comorbidities are frequently encountered in patients with COPD, among which atrial fibrillation (AF) is one of the most prevalent arrhythmias. The coexistence of AECOPD and atrial fibrillation represents a challenging clinical scenario due to shared risk factors such as advanced age, smoking, systemic inflammation, hypoxemia, and autonomic dysfunction. Acute hypoxia, hypercapnia, acidosis, and increased sympathetic activity during AECOPD can precipitate new-onset atrial fibrillation or exacerbate pre-existing arrhythmias. The presence of atrial fibrillation in AECOPD is associated with increased risk of hemodynamic instability, prolonged hospital stay, higher rates of intensive care admission, and increased mortality. Moreover, management is complex as commonly used therapies for COPD, including β-agonists and systemic corticosteroids, may contribute to arrhythmogenesis, while rate-control strategies must be carefully tailored to avoid respiratory compromise. We present this case to highlight the clinical interplay between acute exacerbation of COPD and atrial fibrillation, emphasizing diagnostic challenges, management considerations, and the importance of a multidisciplinary approach in optimizing outcomes in such high-risk patients.
Case Presentation: We report the case of an 84-year-old male, chronic smoker, presented with complaints of progressive shortness of breath, cough with expectoration, for 2–3 days. On admission, the patient was in extreme tachycardia with irregular rhythm of pulse and was tachypneic with use of accessory muscles and hypoxemia. Arterial blood gas analysis revealed type II respiratory failure with respiratory acidosis. Upon examination engorged neck veins with raised JVP; barrel shaped chest with straightening of ribs was seen and upon auscultation bilateral wheeze and crepitations were heard, and chest imaging was suggestive of lower respiratory tract infection. ECG showed atrial flutter with low voltage complexes, and laboratory investigations revealed mild anaemia and evidence of infection.
Keywords: COPD, Acute Exacerbation, Type II Respiratory Failure, Non-Invasive Ventilation, Elderly Patient, Atrial Fibrillation, Atrial Flutter.
How to cite this article: Singla D, Ahlawat RS, Sharma D, Dawood P, Mishra S, Nain S. Acute Exacerbation Of COPD Presenting With Atrial Flutter Progressing Into Atrial Fibrillation: A Case Report. Int J Drug Deliv Technol. 2026;16(29s):13-16. DOI: 10.25258/ijddt.16.29s.3
Source of support: Nil.
Conflict of interest: The authors declare no conflict of interest.