Patients with chronic obstructive pulmonary disease (COPD) can usually keep symptoms such as cough, shortness of breath, or sputum under control, but they're susceptible to exacerbations, or severe worsening of those symptoms, at any time.
"An exacerbation is when a chronic disease gets worse for some reason. With COPD, this is usually because of infection,” explains Richard Castriotta, MD, professor at the University of Texas Medical School at Houston.
COPD exacerbations result in about 1.5 million emergency room visits every year in the United States, but a person's risk of an exacerbation varies depending on the severity of his or her condition. People with severe COPD have about 3.43 exacerbations a year compared with 2.68 on average for people with moderate COPD.
COPD Exacerbations: Signs and Causes
To recognize an exacerbation, look out for these COPD symptoms:
- Worsening cough
- Worsening feeling of being short of breath (dyspnea)
- Changes in sputum, such as changing color (clear to yellow, green, brown, or red) or quantity (either more or less than usual)
Many COPD exacerbations occur without any known cause. However, the most commonly understood causes of COPD exacerbations are respiratory infections such as colds or the flu.
If you have increased COPD symptoms such as a fever, chills, and "purulent" sputum (yellow in color), you should call your doctor immediately. You may need a prescription for antibiotics to help fight the infection.
COPD Exacerbations: How to Handle an Occurrence
How you handle a COPD exacerbation will depend on how controlled your symptoms are under normal circumstances and the severity of the exacerbation. If your symptoms are under control most of the time and your exacerbation is not severe, you should talk to your doctor about treating your symptoms at home. You may be able to use your bronchodilator or steroids to address some symptoms under a doctor's supervision.
If you have followed your doctor's instructions and your efforts to control symptoms at home have not worked, do not take more medication. Instead, call your doctor's office or go to the ER.
If you're having trouble breathing, you should go to the ER immediately. At the hospital, you may receive ventilator treatments or medication to help you breathe. In some instances, you may be hospitalized until you get better.
COPD Exacerbations: Prevention Strategies
There are several ways that you can prevent exacerbations or reduce their severity:
- Stop smoking. The more years you smoke, the worse your exacerbations are likely to be. Chronic and heavy smokers are at increased risk for severe exacerbations.
- Take antibiotics as prescribed. If your doctor gives you antibiotics to treat an infection that might lead to an exacerbation, make sure you take all the medication as your doctor instructs, even if you feel better before you have finished every dose.
- Get your flu shot. Get a flu vaccine every year when flu season begins and make sure that you are up-to-date with your pneumococcal vaccine.
- Find a primary care doctor you can see regularly. Data from a study of 388 COPD patients showed those who did not have a regular doctor were more likely to need visits to the ER. The researchers estimated that 10 percent of hospital visits could be prevented if more people with COPD had regular doctors. Additionally, you can reduce the risk of having to visit the ER with a relapse if you have a doctor you can see about a week after your initial exacerbation and hospital visit.
If you understand which COPD symptoms to watch out for, you will be able to respond to COPD exacerbations quickly and learn how to prevent them in the future.
Last Updated: 12/7/2012