COPD Triggers: How to Prevent a Flare

Host: Carolynn Delany

Guest: Robert T. Schreiber, MD
February 27, 2012

Carolynn Delany:

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.

http://www.everydayhealth.com/copd/podcasts/how-to-prevent-a-copd-flare-transcript.aspx

How Weather Can Affect Your COPD

Weather and temperature changes can trigger COPD symptoms. Here's what you can do.

By Krisha McCoy

Medically reviewed by Cynthia Haines, MD

Weather changes are one of many factors that can trigger your COPD symptoms. Symptoms of COPD, which include shortness of breath, cough, and phlegm production, tend to get worse for some people when the air is very cold and when it is hot and humid.

"Weather extremes are not good," says Barry Make, MD, co-director of the COPD program at National Jewish Health and professor of medicine at the University of Colorado in Denver. Dr. Make says that temperatures below freezing or above 90 degrees Fahrenheit tend to cause COPD symptoms to flare up.

COPD and Weather: When It's Cold and Windy

Cold air and strong winds are known triggers for the worsening of COPD symptoms. Many people with COPD find that cold air can make it harder to breathe, leading to shortness of breath and wheezing. Frigid temperatures can also cause fatigue. "COPD patients just feel like they are more tired after they've been in the cold," explains Make.

Windy days can be practically problematic. "If COPD patients go out when it is windy and have to walk against the wind, there is more resistance," says Make. Therefore, it requires more exertion to walk, which can be difficult for someone with COPD.

If cold and windy climates bother you, try wearing a scarf or face mask loosely over your nose and mouth, and breathe through your nose on wintry days. The winter muffler and breathing through your nose warms the air before it enters your lungs, which can help prevent your symptoms from worsening.

Dealing With Hot, Humid Air

While there are a few people whose COPD symptoms improve in humid weather, most people's symptoms flare up on days of high heat, humidity, or smog. This can especially be an issue when a front moves in that brings humidity, says Make. "A lot of people with COPD tell you that they know when a front is going to come because of a change in their symptoms," he says.

To prevent a flare-up on the hottest and most humid days of the year, stay indoors in an air-conditioned room. "If it is a high-pollution day, we suggest that our COPD patients stay inside and limit their activities," notes Make. "If it is really hot or really cold, we would say the same."

Should You Move?

Seasonal exacerbations of COPD symptoms can be so bad that people will move across the country in an effort to manage their condition. "One of the most common questions we get is what part of the country is best to live in because of the weather," says Make.

In the past, physicians commonly recommended moving to the western United States, where the air is less humid. But it is now known that the COPD-weather connection is very individualized. "It is variable from person to person," says Make. "Some people prefer more humidity and some less."

It is usually not necessary to move when you have COPD, but if you live in a climate with extreme weather changes and moving is an option for you, talk with your doctor. If you decide to move, spend an extended vacation in the new area before you permanently relocate there.

"If people are going to think about moving somewhere for the weather," Make says, "be there during each season of the year." That way you will know if the move will provide year-round improvement of your symptoms.

The best advice for people with COPD is to pay attention to your symptoms during different weather conditions. With help from your doctor, you can learn how to minimize weather-related flare-ups.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/weather-and-copd.aspx

How to Prevent a COPD Flare-Up

Find out how to prevent a COPD exacerbation and what to do if you experience one.

By Madeline Vann, MPH

Medically reviewed by Cynthia Haines, MD

In most cases, patients who have chronic obstructive pulmonary disease (COPD) can keep symptoms such as cough, shortness of breath, or sputum under control. But there are times when COPD patients can experience exacerbations, a worsening of symptoms that is also called a flare-up.

"An exacerbation is when a chronic disease gets worse for some reason. With COPD, this is usually because of infection,” explains Richard Castriotta, MD, professor at the University of Texas Medical School at Houston.

COPD exacerbations result in about 1.5 million emergency room visits every year in the United States. The risk of an exacerbation varies according to the severity of your COPD. People with severe COPD have about 3.43 exacerbations a year compared with 2.68 on average for people with moderate COPD.

COPD Exacerbations: Signs and Causes

The COPD symptoms that you will recognize as an exacerbation are:

• Worsening cough
• Worsening feeling of being short of breath (dyspnea)
• Changes in sputum, such as changing color (clear to yellow, green, brown, or red) or quantity (either more or less than usual)

Many COPD flare-ups occur without any known cause. However, the most commonly understood causes of COPD exacerbations are respiratory infections such as colds or the flu.

If you have increased COPD symptoms such as a fever, chills, and "purulent" sputum (yellow in color), you should call your doctor immediately. You may need a prescription for antibiotics to help fight the infection.

COPD Exacerbations: How to Handle an Occurrence

How you handle a COPD flare-up will depend on how well you have your symptoms under control under normal circumstances and how severe the exacerbation is. If your symptoms are usually under control and your exacerbation is not severe, you should talk to your doctor about how to treat an increase in symptoms at home. You may be able to use your bronchodilator or steroids to address some symptoms under a doctor's supervision.

If you have followed your doctor's instructions and your efforts to control symptoms at home have not worked, do not take more medication. Instead, call your doctor's office or go to the ER.

If you're having trouble breathing, you should go to the ER immediately. At the hospital you may receive ventilator treatments or medication to help you breathe. In some instances, you may be hospitalized until you get better.

COPD Exacerbations: Prevention Strategies

There are several ways that you can prevent exacerbations or reduce their severity:

• Stop smoking. The more years you smoke, the worse your exacerbations are likely to be. Chronic and heavy smokers are at increased risk for severe exacerbations.
• Take antibiotics as prescribed. If your doctor gives you antibiotics to treat an infection that might lead to an flare-up, make sure you take all the medication as your doctor instructs, even if you feel better before you have finished every dose.
• Get your flu shot. Get a flu vaccine every year when flu season begins and make sure that you are up-to-date with your pneumococcal vaccine.
• Find a primary care doctor you can stick with. Data from a study of 388 COPD patients showed that those who did not have a regular doctor were more likely to need to go to the ER. The researchers estimate that 10 percent of visits could be prevented if more people with COPD had regular doctors. You also can reduce the risk of having to go back to the ER with a relapse if you have a doctor you can visit about a week after you go to the hospital with an exacerbation.

If you understand which COPD symptoms to watch out for, you will be able to respond to COPD exacerbations quickly and learn how to prevent them in the future.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/prevent-copd-flare.aspx