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If you have COPD, you may be wondering about COPD exacerbation -- and that's a good thing. Because of the seriousness of an exacerbation, it's important for you to know how they develop, what you can do about them and most importantly, how to prevent them.
COPD Exacerbation: Defined
In simple terms, an exacerbation is defined as a worsening of COPD symptoms. The Global Initiative for Obstructive Lung Disease (GOLD) defines it as "an event in the natural course of the disease characterized by a change in the patient's baseline dyspnea, cough, and/or sputum, that is beyond normal day-to-day variations, is acute in onset and may warrant a change in medication in a patient with underlying COPD".
Causes of COPD Exacerbation: Infection and Air Pollution
The top two causes of COPD exacerbation are bacterial or viral lung infections and air pollution. In one-third of all exacerbation cases however, the cause cannot be identified.
Studies have found that smoking, lack of a pulmonary rehabilitation program, improper use of an inhaler and poor adherence to a drug therapy program are all associated with more frequent episodes of COPD exacerbation. Therefore, it is important that if you've been prescribed treatment for your disease, that you stick to the program and follow your doctor’s orders.
Signs and Symptoms of a COPD Exacerbation
The primary symptom of an acute exacerbation of COPD is increased breathlessness that is often accompanied by the following:
- Increased cough and sputum production
- Change in the color and/or thickness of the sputum
- Chest tightness
Treatment of COPD Exacerbation
Often, either hospitalization or a home-care nurse are necessary for managing an exacerbation. According to GOLD, nurse-administered home care can be a practical - and effective - alternative to hospital care in certain patients with COPD exacerbation. The exact criteria used to determine who would benefit most from this approach, however, is uncertain and varies according to the health care setting.
If your COPD exacerbation cannot be managed safely at home, you will be admitted to the hospital. Once there, your treatment, as determined by your health care provider, may include:
- Oxygen therapy
- Glucocorticosteroids (oral, IV and/or inhaled medications that treat inflammation)
- Antibiotics (if an underlying bacterial infection exists)
- Respiratory stimulants
- Ventilatory support - non-invasive (by mask) or invasive (by means of a tube inserted into your lungs through your mouth)
Prevention is the best approach to managing acute episodes of COPD exacerbation. Preventative strategies that may help you accomplish this goal are as follows:
- Pneumonia and annual flu vaccine (a flu shot can decrease serious illness and death by as much as 50% for patients with COPD).
- Balanced diet, sufficient amount of exercise/activity and adequate sleep
- Avoiding exposure to environmental irritants such as air pollution (pay attention to air quality alerts), extreme temperatures and cigarette smoke (including secondhand smoke).
- Avoid crowds, especially during cold and flu season
COPD exacerbations are debilitating. The toll they take on your body can lead to severe illness, disability and death. Paying close attention to your body, taking better care of yourself and taking steps toward prevention will ultimately help you avoid being hospitalized for COPD exacerbation while preserving your existing lung function.
For further information about COPD exacerbation, be sure to talk with your primary care provider.
Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013. Available from: http://www.goldcopd.org.
Gorski, Lisa MS, RN, CS, CRNI; “COPD Exacerbation: Prevention and Home Management Protocol”. Oasis Answers Inc.