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Thursday, October 8, 2009

What causes COPD exacerbations?

The goal of health care providers in caring for patients Chronic Obstructive Pulmonary Disease (COPD) is to help them maintain a normal quality of life, and continue to be a productive member of society by using the least amount of medications.

Regardless of how well COPD is controlled, many COPD patients have worsening episodes of their symptoms, which is referred to as an exacerbation. Exacerbation's of COPD may include but are not limited to the following:
  • Increased shortness of breath with exertion (while walking or doing normal daily activities)
  • Increased shortness of breath at rest (a sign of severe exacerbation)
  • Increased cough
  • Increased mucus production
  • Thick yellow sputum
  • Chest tightness
  • Increased wheeziness
  • cold-like symptoms
  • chest pain
  • insomnia
  • irritibility
  • fatigue

If you start to notice any of the above listed above what you normally experience with your condition, then you need to seek medical advice immediately.

I can tell you front hand as an RT that those COPD patients who think their new symptoms will just go away on their own are the one's who end up most often being admitted, and having the greatest risk of requiring that a tube be inserted in their throat so we can help them breath and provide their lungs time to heal. Those who wait too long also have the greatest risk of death.

I have had many COPD patients experience what I described in the above paragraph and survive to tell me about. They all usually say something along the lines of: "Never again will I wait that long to come in."

They learn to be gallant COPD patients: see their doctors regularly, take their medications compliantly, know and avoid things and places that trigger their COPD, make necessary lifestyle changes, and call their doctor at the earliest signs of trouble (see list above).

My advice as a respiratory therapist to all my COPD patients is just that: Know the early warning signs of an exacerbation, and call your doctor right away. By doing this, your doctor may be able to treat you from his office and prevent your condition from getting so bad you have to be admitted to the hospital, or rushed to the emergency room by ambulance, or worse.

Be a responsible COPD patient, and know the early warning signs.

That said, there are various things that might cause or contribute to an acute episode of COPD, or contribute to poor COPD control. The following is a list that you should also be aware of:

  • Continued Smoking (we have smoking cessation programs available for you)
  • Bacterial infection (pneumonia) (the #1 cause of COPD exacerbation's)
  • Viral infection
  • Weather changes (this triggers exacerbations of asthma too)
  • Cold weather (be wary of any temperature under 50)
  • overexertion (do you get short-of breath doing normal activities)
  • increased inflammation of unknown origin
  • airway obstruction (You've tried your rescue medicine to no avail)
  • poor compliance with medicine (you feel good so you quit taking it)
  • improper use of inhalers (This is very common. For proper method click here)
  • Poor hygiene
  • Poor education about disease
  • Lack of desire to make necessary lifestyle changes (quit smoking, make home free of things that trigger COPD, such as dust mites, molds, wood smoke, cigarette smoke)
  • Refusal to see a physician (Perhaps the most important after quitting smoking)
  • Refusal to exercise or attend pulmonary rehab (exercise increases your chance of living a normal life. It also strengthens your heart and lungs)
  • Denial (Very common. To get help you first have to seek it)
  • Depression (Also very common and very treatable)
  • Anxiety (Likewise very common.)

Most of these can be treated by the methods listed in this post, "strategies to treat COPD".

The most common ways of treating exacerbations of COPD is with systemic corticosteroids, increased use of bronchodilators such as Xopenex, Albuterol or Duoneb, and possibly antibiotics. If your COPD can't be treated out of your doctor's office, it is very common for COPD patients having exacerbations to be admitted to the hospital.

Most exacerbations last for only a few hours to a few days, depending on how long you wait to see a doctor, and the severity of your disease, and the actual cause of your exacerbation.

Some of my patients I see on a yearly basis. One such patient I've come to know and like (He's a Happy COPDer). He often jokes, "Yep, I've come in for my yearly recharge."

If you have COPD, keep in touch with your doctor. Let him know immediately of any changes, and follow what he says to a tee. Likewise, stay up to date on your COPD wisdom by hanging our right here, at the, or by reading blogs of famous COPD patients like yourself such as COPD News of the Day and Roxlyn's Blog.


dawnp said...

Hi,I just wanted to say that I don't think all gp's are clued up on the problems that copd brings.i have had 2 exacerbations since jan.the first was successfully treated,mainly thanks to the doctor at the out of hours surgery at my local hospital.he gave me 2x anti biotics,and 2nd exacerbation was not treated quite so well.i visited my gp,who prescribed anti biotics...when I mentioned that I normally have steroids as well the reply I was given was " steroids are bad for you". Unfortunately,I was very ill due to my gp's stupidity,and I am still recovering now,and this was in feb.

Nancy said...

I think I would not only be finding a good pulmonologist but a new gp for sure. Sometimes some gp's fail to make referrals when they should.