An Overview of COPD Exacerbations

Learn to recognize and manage COPD flare-ups

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When you have chronic obstructive pulmonary disease (COPD), you might experience occasional exacerbations (flare-ups). These episodes are characterized by severe shortness of breath and a sense of chest tightness. Exacerbations can occur as a result of an infection, exposure to irritant fumes, or for other reasons, and they can also happen without an identifiable cause.

When you experience a COPD exacerbation, you may need to use rapid-acting treatment, such as a bronchodilator inhaler. Sometimes, a COPD exacerbation requires urgent medical care or hospitalization.

While exacerbations are often treatable, they can be dangerous. And having too many exacerbations worsens COPD. Preventing COPD flare-ups is an important part of living with this disease.

Symptoms

Some people rarely experience COPD exacerbations, while others have frequent episodes. You may experience COPD symptoms like fatigue, wheezing, and exercise intolerance on a regular basis—or even every day.

What you experience during an acute COPD exacerbation is different from your typical COPD symptoms. These episodes are usually associated with a sense of distress, and the effects are more severe than the symptoms you normally experience when your condition is under control.

Symptoms of a COPD exacerbation may include:

  • Shortness of breath
  • Dyspnea (trouble catching your breath)
  • An increased cough with or without visible mucus
  • A change in the color, thickness, or amount of mucus
  • More noticeable wheezing than usual
  • Chest tightness
  • Using your abdominal and neck muscles to help you breath
  • Fever (a sign that you also have an infection)
  • Tachypnea (rapid breathing)
  • Severe anxiety, fear, or a sense of doom
  • Dizziness, lightheadedness, or a feeling that you might faint

Sometimes, COPD exacerbations worsen gradually over a few days, but they can also seem very sudden, worsening within a few hours. They can also be fatal. It is important that you seek medical attention when you experience these symptoms.

If your medical team has already given you instructions on how to manage your COPD exacerbations at home, be sure to initiate treatment right away—do not delay your treatment.

Causes

COPD is often described as an obstructive pulmonary disease. This is because the bronchi (airways) are partially blocked due to mucus, inflammation, and lung damage.

When your lungs are already damaged from COPD, anything that furthers inflammation and mucus can challenge already compromised airways, constricting them and making it more difficult to breathe than usual.

Some of the factors that can lead to an exacerbation include:

  • A bacterial, viral, or fungal lung infection (such as bacterial pneumonia)
  • Exposure to fumes, cigarette smoke, or air pollution
  • Airborne allergens such as dust, pollen, and pet dander

While anyone who has COPD can experience exacerbations, you are more likely to experience these episodes if you smoke, if you have severe COPD, and if you are not consistently using your medication.

Stress, fatigue, lack of nutrition, and sleep deprivation can all make you prone to infections and COPD exacerbations as well. It's also possible to have a flare-up without a precipitating factor.

Diagnosis

A COPD exacerbation is often diagnosed based on the symptoms of worsening chest tightness and shortness of breath. Your medical team may give you instructions regarding when to use medication for a COPD exacerbation.

You may be advised to take steps such as counting your breaths per minute or checking your own oxygen level at home with a pulse oximeter. However, if your oxygen is normal but you still feel respiratory distress, your doctor may recommend that you use your at-home treatment.

In a medical care setting, you may have several tests to confirm a COPD exacerbation and to look for a cause. Diagnostic tests that you may need include:

  • Chest X-ray or computerized tomography (CT): Your doctors can use these imaging tests to identify changes in the structure of your lungs.
  • Oxygen level: You will likely have your blood oxygen level checked with a non-invasive pulse oximeter.
  • Sputum culture: A sputum sample may help identify an infectious organism that can be treated with antibiotics.
  • Arterial blood gas: A blood sample can be used to measure your blood oxygen, carbon dioxide, and bicarbonate saturation, as well as your blood pH. These can be altered during a COPD exacerbation.

Treatment

Because COPD can differ from one individual to the next, you need to work with your doctor to design a treatment plan appropriate to your condition and lifestyle. You might be able to manage your exacerbations with rescue bronchodilators, inhaled steroids, and/or oxygen supplementation at home.

These medications are fast-acting, and they work by helping open the airway passages and reduce inflammation.

Urgent Care

There are cases, however, when COPD exacerbations can severely inhibit your breathing. When this happens, you might need emergency treatment in a hospital setting.

Interventions often used in the treatment of a severe COPD exacerbation include:

Mechanical ventilation is a temporary intervention. You will be unable to speak while you are intubated, and your oxygen and carbon dioxide levels will be carefully monitored so your medical team can determine when it is safe to remove the breathing tube from your windpipe.

Antibiotics

If you have a bacterial lung infection, you will need antibiotics. These are prescription medications that kill bacteria. However, they are not effective for the treatment of viral or fungal lung infections. Viral infections usually improve without antimicrobial treatment and fungal infections are treated with antifungal therapy.

If your doctor prescribes an antibiotic for you, your symptoms may improve before your prescription is finished. Nevertheless, it is important that you finish your whole dose so that you will not have a recurrence of a partially treated infection within a few weeks.

Taking antibiotics when you do not have a bacterial infection can lead to problems such as aggressive antibiotic-resistant infections, so only do so when advised by your doctor.

Prevention

Prevention is important if you are at risk of COPD exacerbations. Lifestyle strategies and medications can reduce infections and exposure to inhaled irritants. Taking your COPD medications can optimize your lung function, making you less susceptible to the effects of lung inflammation and mucus accumulation.

Preventative strategies you can use to avoid a COPD exacerbation include:

Pulmonary Rehabilitation

Many people who have COPD can benefit from supervised rehabilitative techniques that include breathing exercises, pulmonary hygiene, and a physical exercise routine. You might also be advised to use pulmonary exercise equipment in your home.

The idea of pulmonary rehabilitation is to maintain physical and pulmonary conditioning. This can optimize your lung function to prevent a decline in your respiratory abilities.

A Word From Verywell

A COPD exacerbation can interfere with your life, potentially involving a hospital stay. Recurrent COPD exacerbations worsen COPD, which results in a downward spiral. Recognizing and treating a COPD exacerbation is important, but prevention can be an effective way to reduce the decline of your COPD.

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Article Sources

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  1. American Thoracic Society, Patient Education/ Information Series, Exacerbation of COPD

  2. Dobler CC, Morrow AS, Farah MH, Beuschel B, Majzoub AM, Wilson ME, et al. Pharmacologic and Nonpharmacologic Therapies in Adult Patients With Exacerbation of COPD: A Systematic Review [Internet].Rockville (MD): Agency for Healthcare Research and Quality (US); 2019 Oct. Report No.: 19(20)-EHC024-EF. AHRQ Comparative Effectiveness Reviews.

  3. Ko FW, Chan KP, Hui DS, et al. Acute exacerbation of COPD. Respirology. 2016;21(7):1152-65. doi:10.1111/resp.12780

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