Staying Healthy and Avoiding Exacerbations:by David Crabtree, M.D. (Central Illinois Allergy and Respiratory Clinic)
By centralilli55968110, Sep 8 2016 05:21PM
This month on our CIARS Information Site, we will discuss the common but often
misunderstood diagnosis of acute exacerbation of Chronic Obstructive Pulmonary
Exacerbation of COPD:
An acute exacerbation of COPD is a flare-up or episode when your breathing gets worse than usual and you become
sick. It is most often linked to an infection. Exacerbations can be serious, causing you to call your health care
provider, go to the emergency room, or stay overnight in the hospital. Having exacerbations often can actually cause
your COPD to progress faster. In many cases an exacerbation is from an infection in the lungs, but in some cases,
the cause is never known. The inflammation (irritation and swelling) in the lungs during and after an exacerbation
of COPD can cause some people to be extremely ill and often it takes a long time to recover completely.
What causes an exacerbation?
The major cause of an exacerbation is infection in the lungs (air sacs) or airways (breathing tubes). This infection is
often from a virus, but it may also occur from bacteria or other organisms. Exacerbations can also occur from
inhaling irritating substances from the environment like heavy air pollution or from severe allergies. The lungs react
to infection by developing inflammation (irritation and swelling). This makes the airways narrow and blocked from
muscle tightness, swelling and mucus. Exacerbations can come on very quickly (hours to days), while finding out
what causes the exacerbation can be a very slow process. Medications known to treat symptoms of an exacerbation
are therefore often given without finding out the exact cause. There are no tests of the blood, sputum or chest x-rays
that have been found to diagnose an exacerbation. Thus, the best person to help identify an exacerbation early is
you. Knowing the signs and symptoms of an exacerbation and getting help early, are the very best ways to decrease
the duration of the exacerbation, and limit it from becoming very severe, prolonged, and life threatening. You can
learn to avoid acute exacerbations by recognizing early warning signs and then taking action to stop them in their
tracks! The best way to do this is to work with your health care provider (CIARS) on an action plan so you know
what to do to treat an exacerbation before it becomes serious.
Early warning signs of an acute exacerbation:
• Wheezing, or more wheezing than what’s normal for you
• Coughing more than usual
• Shortness of breath that is worse than usual
• An increase in the amount of mucus
• Change in the color of your mucus to yellow, green, tan, or
• More tiredness (fatigue), unusual trouble sleeping and eating
• Shallow or rapid breathing, worse than normal for you
• Changes in skin or nail color. You see a bluish tint around your
lips or nails
• Confusion or excessive sleepiness
• Swelling in your feet or ankles
• Early morning headaches. You start the day with a throbbing
head, because low O2 levels or a buildup of CO2 in your blood.
COPD Exacerbation Prevention: Medical Treatments:
◆ Vaccines — Influenzae every fall, Pneumovax 23, Prevnar 13, dTAP, Zostavax all are recommended
◆ Inhaled corticosteroids and long -acting bronchodilators (ICA/LABA or ICS/LAMA)
◆ Combination Inhalers — LAMA+LABA (Anoro, Stiolto) or combinations of 2 single agents
◆ Triple Therapy with ICS, LABA, LAMA: May Prevent Hospitalization (by nearly 50%) the same as the combination inhalers but also decreases symptoms and increases lung function.
◆ Phosphodiesterase inhibitors — these include an old but still useful drug Theophylline, and a newer drug called Roflumilast or Daliresp (17% reduction in exacerbations and higher reductions in hospitals) Of note, the patients who did the best with this drug were the Obese COPD patients.
◆ Use of antibiotics to prevent exacerbations — mainly beneficial in the less severe and bronchiticpatients but significant reductions of > 40% reduction in the number of exacerbations and seven exacerbations. Side effects were not without significance and must be used only on an individual (case-by-case basis)
◆ Pulmonary rehabilitation, home oxygen, and ventilatory support — There is some evidence from clinical trials that pulmonary rehabilitation programs reduce hospital stay. Epidemiological studies in COPD patients have provided some evidence that long-term oxygen therapy and noninvasive ventilatory support may reduce hospital admission and prevent exacerbations.