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

COPD Blog: Why DON'T I Need Oxygen?

Robert T. Schreiber, MD, an American Lung Association in New York expert

Many patients with moderate to severe COPD get short of breath doing light activities and then wonder if they need oxygen. Although oxygen is necessary for some, many patients don’t need it, even when they are symptomatic. When these patients are told that oxygen won’t help them, they don’t always understand why.

Air is made of various gases, 21 percent of which is oxygen. When we breathe in, air travels down the trachea, or windpipe, and into the bronchial tubes. There are 20 to 25 generations of branching bronchi, which then lead to the alveoli, small little sacs where oxygen diffuses into the bloodstream. Most of the oxygen in the blood is carried by our red blood cells, bound to a protein called hemoglobin. The blood cells then travel through arteries throughout the body and release oxygen to the organs that need it. For example, when we are active, more blood is sent to our muscles, which need oxygen to allow us to move around and exercise.

Usually when we feel short of breath, we don’t need more oxygen — that is, we’re not lacking oxygen in our blood. The feeling of dyspnea (the medical term for shortness of breath) is a complicated sensation. The brain is affected by many factors, such as how hard the respiratory muscles are working, the stretch and degree of inflation of the chest wall and diaphragm, the pH and oxygen levels in the blood, and heart rate. These inputs are sorted out in the brain and may then cause the sensation of shortness of breath. So, dyspnea is not necessarily from lack of oxygen.

As an example, imagine a healthy 18-year-old woman running a race as fast as she can. At the end of the race, she may feel short of breath from working so hard, but if you measure her oxygen level, it will not be low! And giving her oxygen will not stop her from feeling short of breath.

On the other hand, sometimes lack of oxygen doesn’t cause any symptoms. An example is a fighter pilot flying at very high altitudes where the air is “thinner,” meaning it contains less oxygen. Pilots have been known to black out due to lack of oxygen, yet they never felt short of breath. This is why they have to wear oxygen masks at high altitudes.

So, our oxygen levels don’t always correlate with feeling short of breath. We can have dyspnea with a normal blood oxygen level, and we can have no symptoms but a low oxygen level.

Blood oxygen levels can be measured directly by taking a small blood sample from an artery and testing it. This is called an arterial blood gas test. Alternatively, a pulse oximetry can indirectly measure the percentage of hemoglobin with oxygen in the red blood cells by placing a probe on a finger or ear lobe.

As a patient with COPD, your health care provider may determine your oxygen levels at rest, while sleeping, or during exercise to see if oxygen may help you. If your oxygen levels are low, oxygen therapy will help reduce the strain on your heart, brain, and muscles, and using oxygen as directed may help you feel better. However, if your levels are normal or only drop a little bit, oxygen won’t help your condition. So, don’t be surprised if you’re told you don’t need it!

Dr. Schreiber is board certified in internal medicine and pulmonary diseases by the American Board of Internal Medicine. He is a member of Nassau Chest Physicians, P.C., who are actively involved with the American Lung Association in New York. Schreiber is director of the SICU at St. Francis Hospital, medical director of the Oyster Bay Cove Village Police Department, and a member of the Nassau County Medical Reserve Corps. He is on the professional staffs of St. Francis Hospital, North Shore University Hospital (Manhasset and Plainview), and St. Joseph Hospital.

gotquestions  http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/why-dont-i-need-oxygen-blog.aspx