Guest: Robert T. Schreiber, MD
February 27, 2012
Carolynn Delany:February 27, 2012
Welcome to this Everyday Health podcast, “COPD Triggers: How to Prevent a Flare.” I'm your host, Carolynn Delany. Anyone coping with chronic illness knows there are good days and bad days. We're here today to become more aware and hopefully prevent those bad days from happening as often. Joining us today is Dr. Robert Schreiber, a pulmonary medicine specialist at Nassau Chest Physicians and director of the surgical ICU at St. Francis Hospital in Roslyn, New York. Dr. Schreiber and Nassau Chest Physicians are also actively involved with the American Lung Association in New York. Thanks for being with us today, Dr. Schreiber.
Dr. Schreiber:
I'm very glad to be here with you today, Carolynn.
Carolynn Delany:
Dr. Schreiber, we hear the terms "trigger" and "flare" quite often. Can you please help us understand what they mean and why certain elements cause COPD symptoms to flare?
Dr. Schreiber:
Carolynn, we use the words "flare" and "exacerbation" interchangeably for our patients with COPD, and what this really refers to is a temporary worsening of their emphysema [or chronic bronchitis]. Patients will have increased shortness of breath, wheezing, and coughing, and frequently we'll see increased sputum production. The sputum may change and be increased in terms of amount, thickness, color, going from clear to gray or yellow, and even sometimes bloody.
Carolynn Delany:
Dr. Schreiber, what are some common COPD triggers that can actually cause the flare‑up to happen?
Dr. Schreiber:
Carolynn, I think the number one trigger that we see would be infections. This can be anything from a cold to more serious things like bronchitis or pneumonia. Other things that we commonly see causing flare‑ups can be exposure to smoke, whether primary smoke from the patient smoking themselves or inhalation of secondhand smoke if they are out in a restaurant or some other venue where other people are smoking and they inhale other people's smoke.
Of course, other things like weather, whether it be hot or cold or humid or dry air, can also affect many people. Air pollution is a common trigger for many of our patients, particularly in those hot, humid days during the summer when the air quality gets very bad. That's a frequent cause of triggers during those air polluted days. And just general stress sometimes can bring on an exacerbation.
Carolynn Delany:
Well, you know, you mentioned avoiding smoking and being around others who are smoking. Is it also important to stay away from chimney smoke and stovetop smoke?
Dr. Schreiber:
Certainly for some people this can also be an irritant and trigger for a COPD exacerbation. Smoke is composed of a variety of chemicals, including particulates of carbon and all sorts of chemicals, and may have carbon monoxide sometimes, so our patients with COPD have to be careful around any type of smoke. Usually chimney smoke and stovetop smoke aren't toxic, but they can act as irritants.
Carolynn Delany:
Well, a flare‑up can happen at any time and all of the triggers you've mentioned are good ones to look out for, but are there others that only affect some people? If so, how should they learn to identify, watch out for, and deal with them?
Dr. Schreiber:
Different people will flare up from different triggers. The most important thing that I can do as a doctor is not sit down and say to someone, “you have to avoid,” and then give them a list of things. You have to tell them, “Listen, you have to pay attention to what bothers you.”
I don't play ice hockey, but I love to watch it, and there's a phrase that you have to skate with your head up, which really means that you have to look around you and be aware of your environment and see what's going on all the time, and that's really what it's about for our patients. You have to tell them, “Pay attention to what's going on, see what bothers you, and then, of course over time, you can learn what you can and cannot be around so that you can breathe more easily.”
Carolynn Delany:
That's a good point. I mean, some people might be more sensitive to extra dust in their home or scented laundry detergents, but it may not bother anybody else.
Dr. Schreiber:
That's exactly correct. I think in general, most people need fresh, circulating air so that nothing particularly settles or irritates their lungs. Other triggers, though, you have to kind of learn about those things, as you mentioned, like the scented laundry or fragrances and stuff, and see what really bothers you or not.
Carolynn Delany:
Well, why is it important for someone with COPD to maintain his or her overall health?
Dr. Schreiber:
The current state of the art in pulmonary medicine suggests that COPD exacerbations can gradually cause further loss of lung function, and clearly as healthcare professionals we all want to preserve our patients' lung function so that they can stay healthy, remain independent, and continue to perform their activities of daily living as best as possible. I think everyone feels that that should be a goal for themselves, and we as physicians want to try to do that for our patients.
Trying to stay healthy is really the most important thing here. As I said, infections are probably the number one cause of triggers, so hand washing and sanitizers will help prevent picking up colds. Obviously, if you know somebody is sick it's best to stay away from them. And immunizations are important to try to help prevent people catching influenza and pneumonia.
Carolynn Delany:
I see. I see. All great tips. Well, if you do find yourself in a flare what's the first and perhaps best thing you can do to help treat it and get you back to feeling normal?
Dr. Schreiber:
I think we all have to think of having a plan and that life is not just full of surprises, so patients with COPD have to recognize that things are going to happen, and what am I going to do when it happens. So the first thing to do is to remove yourself from the trigger if it's possible.
There is a way of breathing we call pursed-lip breathing where you breathe in through your nose and out through your mouth with your lips together when you exhale, and this helps to control the breathing pattern. It helps you breathe more efficiently. If you do it slowly, you get actually more oxygen in with less work of breathing, and that's a very helpful technique that your healthcare provider could probably teach you to do.
When the trigger happens, I tell my patients to drink extra fluids and try to get some extra rest. I almost always will have them have available a quick‑acting medication. Usually it's an inhaler, although sometimes it's a nebulized medicine that they can inhale that should help to open up the bronchial tubes.
And of course, if these things don't help they should really get in touch with their healthcare provider to see if there can be an adjustment of their medicines, see if they need a stronger bronchodilator or an antibiotic or possibly a course of prednisone. If those things fail, sometimes emergency room treatment or hospitalization even is required, but hopefully we can cut that off at the pass and try to keep people away from the hospitals.
Carolynn Delany:
Right. Well, Dr. Schreiber, thank you for sharing great information about how to recognize and prevent a flare when you're living with COPD.
Dr. Schreiber:
Well, Carolynn, as always it's my pleasure to speak with you and help our patients. And don't forget our patients should also contact their local chapter of the American Lung Association for further tips because they're a great resource for more information, too.
Carolynn Delany:
They certainly are. You've been listening to an Everyday Health podcast, “COPD Triggers: How to Prevent a Flare.” For more information on COPD, visit EverydayHealth.com. I'm Carolynn Delany for Everyday Health. Thanks for joining us.
