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 without any 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 the condition.

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.

An acute COPD exacerbation is different than 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 COPD is under control.

Sometimes, COPD exacerbations worsen gradually over a few days, but they can also seem very sudden, worsening within a few hours.

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

A COPD exacerbation may abruptly worsen, and it can even 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

While anyone who has COPD can experience an exacerbation, 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.

There are a number of factors that can trigger a COPD flare-up, including:

  • 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

Stress, fatigue, lack of nutrition, and sleep deprivation can all make you prone to infections and COPD exacerbations. We know that there are issues that provoke COPD exacerbations, but sometimes you can have a flare-up even without a precipitating factor.

Airway Constriction

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.

Irritants—such as inhaled environmental particles and the organisms that cause lung infections—trigger an inflammatory response. When your lungs are already damaged, inflammation and mucus can further constrict your airways, making it more difficult to breathe than usual.

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, you feel respiratory distress, your doctor may recommend that you use your at-home treatment even if your oxygen is normal.

In the 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, including problems such as pneumonia, blood, or fluid.
  • Oxygen level: You will likely have your blood oxygen level checked with a non-invasive pulse oximeter.
  • Sputum culture: Your 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.
  • Pulmonary function tests (PFTs): Breathing tests that measure the amount of air you can inhale (breath in) and exhale (breath out) can be helpful in assessing your respiratory function, especially when these results are compared to values obtained when you were not having 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

However, COPD exacerbations can severely inhibit your breathing, and you might need emergency treatment in a hospital setting.

Interventions used in the treatment of a 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. And taking antibiotics when you do not have a bacterial infection can lead to problems—such as aggressive antibiotic-resistant infections down the road.

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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