COPD is a chronic, incurable condition that makes breathing difficult and can have a ripple effect on everything you do in your day-to-day life. The COPD Foundation reports that 30 million Americans are affected by the disease. In addition to their daily struggle to breathe, COPD patients may also experience complications of the disease — dubbed exacerbations — that can make it even harder to live with COPD. These exacerbations can sometimes result in lengthy or expensive hospital stays.
According to a statistical briefing from the Agency for Healthcare Research and Quality, “In 2008, there were about 822,500 hospital stays for chronic obstructive pulmonary disease among adults age 40 years and older.” Acute exacerbations accounted for 514,000, or 62.5 percent, of all COPD stays, the briefing states.
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So what’s an exacerbation, and how can you prevent one from landing you in the hospital?
Dr. Barry Make, a pulmonologist and professor of medicine at National Jewish Health in Denver, says many patients don’t fully understand what an exacerbation is. “Sometimes they’ll use the terms bronchitis, cold, flu, chest cold. Any of those can be a COPD exacerbation, and these terms are all used very loosely. But a COPD exacerbation is a worsening of lung systems beyond the normal day-to-day variability.”
Dr. Umur Hatipoglu, director of the COPD Center at the Respiratory Institute at Cleveland Clinic, agrees that the term exacerbation can be a tough one for patients, and sometimes even doctors, to fully grasp because it’s a “scientifically ambiguous definition. Basically, what it means is an acute worsening of a patient’s existing respiratory symptoms that requires a change in treatment.”
This is different than the usual, day-to-day variations you’ll experience when living with COPD, Make says. With COPD, “some days are worse than others. One day you’ll be able to take a long walk, but the next you’ll be short of breath. Those things are normal. An exacerbation is something out of the ordinary.” He says coughing more, producing more phlegm, wheezing or producing yellow or green sputum can all be signs of an exacerbation.
Although the term may be hard to define scientifically, clinically it’s relatively easy to spot an exacerbation when a patient is dealing with one. Hatipoglu says the primary indicators are what he calls the three cardinal symptoms. “You can diagnose it readily by seeing that the patient is coughing more, producing more phlegm and is more short of breath.” There are other signs of exacerbations, but those three are the most likely indicators.
So what causes these problems? A number of potential triggers may be responsible, but Hatipoglu says it’s typically an infection of some sort. Pneumonia and influenza are common culprits, but allergies and exposure to smoke, fumes or other pollutants can also trigger exacerbations.
Regardless of what’s triggered an exacerbation, you should pay attention to the symptoms and seek treatment in certain instances. Hatipoglu says that exacerbations are linked with mortality and a lower quality of life in patients with COPD. “We don’t know that they cause mortality per se,” he says, “but we know that they make people miserable, so they should be avoided.”
There’s also a concern that some symptoms of an exacerbation can mimic other potentially deadly problems such as heart attacks and pulmonary embolisms, so it’s important to get checked out if something seems to have changed significantly. “If there is any uncertainty in the patient’s mind about the nature of the symptoms, they should call their physician,” Hatipoglu says.
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Still, not every exacerbation requires a visit to the doctor. If you’ve experienced similar symptoms in the past and have communicated with your doctor, you may be able to relieve some of the symptoms yourself by using an inhaler or other medication your doctor prescribes. Make calls this approach “collaborative self-management” and says he encourages some of his patients to help themselves when they can. “We want patients to recognize things and help treat themselves in collaboration with their health care provider.”
Make also recommends calling your doctor on the phone when you’re having an issue rather than just waiting until your next scheduled appointment. ” Patient communication with the physician is important. If in doubt, call.”
Hatipoglu agrees. “If the patient is unsure about the nature of the symptoms, of course, it’s very prudent to check with a medical professional. On occasion when the symptoms are quite typical, we do advise patients to start self-treating by short-acting bronchodilators and using oral anti-inflammatories like prednisone or antibiotics.”
Exercise is generally encouraged for COPD patients, but Hatipoglu says it’s not recommended during an exacerbation. Pulmonary rehabilitation — a combination of exercise training, nutritional advice, education and counseling that can help rebuild lung strength — is a recommended treatment to help manage the disease day to day, but it also isn’t advised during an exacerbation. “This doesn’t mean that they need to be bed-bound and rest. They need to do the exercise or the exertion level that they’re able to tolerate. Typically, patients will not tolerate their usual exercise regimen during an exacerbation because the airway is further narrowed and they’ll get short of breath quickly. And we have really no data that shows that exercise regimen is feasible or necessary during an exacerbation,” he says.
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But before you even get to the exacerbation stage, there are things you can do to help yourself avoid them. Hatipoglu says an important but underemphasized aspect of coping with exacerbations is keeping them from happening in the first place. “Prevention is very important, and the first thing that the patients can do to prevent exacerbations is to get vaccinated” against the flu and pneumonia.
Taking your prescribed medications on schedule as your doctor recommends can also keep exacerbations from flaring up. Eating right and getting enough sleep can help as well. But probably the most important thing to do, if you haven’t already, Hatipoglu says is to quit smoking. “This recommendation is not only important for preventing exacerbations, but it’s one of the things that improves longevity in COPD.”
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When COPD Gets Worse, Problems Are Called Exacerbations originally appeared on usnews.com
