What is a COPD exacerbation?
An exacerbation is generally a period in which COPD gets worse. It can last from days to weeks, even a month or so. Patients experience increasing shortness of breath, an increase in sputum production and even a colour change in the sputum to green. It is generally associated with a chest infection which makes the COPD worse. It often leads to hospital admission.
Patients feel very lethargic and can be quite unwell with them, but with the right antibiotic therapy and other treatments make complete recovery. Occasionally if exacerbations are frequent patients are prescribed an on going low dose antibiotic to prevent future ‘attacks’.
Treatment for a COPD exacerbation
The symptoms or signs of exacerbation are similar to those of pneumonia or an infection. The color and amount of sputum is also important to note. A change in the color of sputum from clear to deep green or yellow, red or brown, or the amount of sputum, and an increase in shortness of breath, are typical symptoms and signs of exacerbation.
If a person is hospitalized for complications of COPD, they will probably be prescribed antibiotics, oxygen therapy and have chest x-rays taken, in addition to several types of blood tests. The tests that are ordered will help to guide the physician on how to best treat the patient. At times, despite all treatments, the lungs will be unable to appropriately take in Oxygen. In that event, a person may require a ventilator, in order to help them breathe. Once a patient is on a ventilator it can be a long and slow process to remove them from it. In some instances, when an infection begins to go away, a patient can be taken off of a ventilator in less than a week. At other times, it can take several weeks or even months for a patient’s lungs to regain strength. There can also be cases when the patient is unable to breathe again without the use of a ventilator.
Continuous use of a ventilator for an indefinite amount of time is referred to as ventilator dependency. A patient, their family and their physician should always discuss what they would like to have done if they are ever in a position where they will require a ventilator permanently or temporarily. The preferences and views of a patient when it comes to the choices for ventilator use, or other types of therapy can be outlined in a document, referred to as an advanced directive.
While a patient may experience more shortness of breath than usual when suffering from an exacerbation, pneumonia or bronchitis, these conditions will not necessarily require a person to be hospitalized. The patient’s physician will determine whether they need to be admitted based on their medical history and symptoms.
Acute exacerbations of COPD can be a major problem for some people who are trying to cope with this disease. Attacks or exacerbations usually occur more often in people who are suffering from stage three or four COPD, and these disease flare ups can either cause or signal a more rapid progression of chronic obstructive pulmonary disease, over time.
An exacerbation is hard to define: the only widely accepted definition is a persistent and significant worsening of breathing in a patient with COPD, requiring a reevaluation of medications- usually including antibiotics and systemic corticosteroids, in order to help the patient to recover. While most exacerbations will not require the patient to be hospitalized, it can take days or weeks of coughing, shortness of breath, and a decline in the quality of life. A patient’s pre-exacerbation exercise ability and lung function often will not fully return after recovery from an infection or attack.
Because exacerbations cause a worsening of the disease and can significantly shorten a patient’s life expectancy, preventing these attacks from occurring is a major goal of physicians.
Corticosteroids are typically prescribed as the first line of therapy, when treating an attack, however, it’s not clear whether this type of medication therapy is effective in preventing COPD exacerbations. This type of medication therapy tends to be more effective in patients who are in stage one or stage two of COPD.