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

COPD Myths and Truths

COPD is often misunderstood because symptoms can be caused by three different diseases. Separating fact from fiction will help you live better and better manage COPD.

By Chris Iliades, MD

Medically reviewed by Lindsey Marcellin, MD, MPH

Chronic obstructive pulmonary disease (COPD) can be confusing because it isn’t a single condition — it actually refers to a group of lung diseases that makes it difficult to breathe.

"COPD is an umbrella term for three different diseases," says Timothy R. Wu, MD, director of the COPD Center at Lahey Clinic in Burlington, Mass. Emphysema, chronic bronchitis, and chronic asthmatic bronchitis can all cause COPD symptoms. What these diseases have in common is obstructed air flow through the lungs.

Common misunderstandings about COPD include that it only occurs in older smokers and that nothing can be done about it. However, that’s not necessarily the case. To better understand COPD and how to live with it, start by learning how to separate the myths from the facts.

Myth or Truth: Only Smokers Get COPD

COPD symptoms such as cough, shortness of breath, and frequent lung infections are among the most common symptoms experienced by long-term smokers. While emphysema, chronic bronchitis, and asthmatic bronchitis are usually caused by smoking, there are other causes as well. "Smoking is almost always the cause of COPD in the United States, but in many parts of the world, COPD may be more commonly caused by wood smoke from cooking fires," says Dr. Wu. Other non-smoking causes include:

• Some progressive forms of asthma
• Being born without a protein called alpha-1 antitrypsin
• Workplace exposures to gases and fumes
• Heavy exposure to secondhand smoke or air pollution

Myth or Truth: COPD Only Occurs in Older People

COPD is more common in older people who have smoked for many years, but a simple test called spirometry may detect early changes from COPD in younger people. Spirometry is a lung function test that involves blowing into a small machine that measures lung capacity. This test can be read immediately, and it is a reliable way to make a diagnosis.

"Even before COPD symptoms develop, the early changes of emphysema or bronchitis may be present," says Wu. "If younger smokers are screened with spirometry, COPD may be diagnosed in people as young as 30 or 40."

Myth or Truth: People With COPD Need to Slow Down

COPD symptoms may make some types of activity difficult, but slowing down is not good for those with COPD. Physical therapy, including breathing exercises and exercises to strengthen the arms and shoulders, can be an important part of treatment. Regular exercise along with a healthy diet helps muscles stay strong, and that reduces the demand placed on the lungs.

People with COPD should also try to stay active socially. Isolating yourself at home can lead to depression, which can make symptoms worse. It is important to stay in touch with friends and family and maintain a good support network. Many people with COPD also benefit from participating in support groups.

Myth or Truth: There Is No Treatment for COPD

The biggest myth about COPD is that you can't do anything about it. Although there is no cure for COPD, it can be treated and managed in many people. "How well COPD can be treated depends on how advanced it is and what other diseases may be present, such as hypertension and heart disease," says Wu. You can slow down the progression of COPD by:

• Taking medication as directed
• Getting pulmonary rehabilitation
• Using oxygen as needed
• Stopping smoking

With these changes, many people are able to manage their COPD symptoms well. If you smoke, even if you are still in your 30s, ask your doctor to check your lung capacity. Many of the irreversible effects of chronic bronchitis, emphysema, and chronic asthmatic bronchitis can be avoided with early diagnosis and treatment.

"It is never too late to stop smoking. As soon as you quit, your lung function starts to improve," says Wu, although lung function will never get back to normal once COPD starts. COPD symptoms develop over time, and changes in your lungs may have already started without you knowing it. The best time to stop smoking is right now.

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

Living With COPD

With ongoing care and preventive strategies, you can manage your COPD symptoms and keep them under control.

By the National Heart, Lung, and Blood Institute

COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progress of the disease. You can:

• Avoid lung irritants
• Get ongoing care
• Manage the disease and its symptoms
• Prepare for emergencies

Avoid Lung Irritants

If you smoke, quit. Smoking is the leading cause of COPD. Talk to your doctor about programs and products that can help you quit. Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program.

Try to avoid secondhand smoke and other lung irritants that can contribute to COPD, such as air pollution, chemical fumes, and dust. Keep these irritants out of your home. If your home is painted or sprayed for insects, have it done when you can stay away for awhile.

Keep your windows closed and stay at home (if possible) when there's a lot of air pollution or dust outside.

Get Ongoing Care

If you have COPD, it's important to get ongoing medical care. Take all of your medicines as your doctor prescribes. Make sure to refill your prescriptions before they run out. Bring all of the medicines you're taking when you have medical checkups.

Talk with your doctor about whether and when you should get flu and pneumonia vaccines. Also, ask him or her about other diseases for which COPD may increase your risk, such as heart disease, lung cancer, and pneumonia.

Manage COPD and Its Symptoms

You can do things to help manage your disease and its symptoms. Depending on how severe your disease is, you may ask your family and friends for help with daily tasks. Do activities slowly. Put items that you need often in one place that's easy to reach.

Find very simple ways to cook, clean, and do other chores. Some people find it helpful to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things. Ask for help moving things around in your house so that you will not need to climb stairs as often.

Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.

Prepare for Emergencies

If you have COPD, knowing when and where to seek help for your symptoms is important. You should seek emergency care if you have severe symptoms, such as trouble catching your breath or talking.

Call your doctor if you notice that your symptoms are worsening or if you have signs of an infection, such as a fever. Your doctor may change or adjust your treatments to relieve and treat symptoms.

Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have on hand directions to the doctor's office and hospital and a list of all the medicines you're taking.

Source: The National Heart, Lung and Blood Institute (NHLBI). The NHLBI does not recommend or endorse any company advertised on this site.

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

Doctor says she 'sees babies lost because of smoking'

 By Jim Taylor
              Newsbeat reporter

"This is a day to day reality for me. I see babies being lost to smoking."

Dr Shonag Mackenzie is an obstetrician based at Wansbeck General Hospital in Northumberland.

It's her job to deal with the impact of smoking during pregnancy in an area with one of the highest smoking rates in the UK.

"Cigarettes have about 4,000 chemicals in them but the one that seems to affect babies is carbon monoxide.

"We can prove there's a direct chemical effect. The more you smoke, the more likely you are to harm the baby."

Around 120,000 of the 700,000 babies born each year in England and Wales are born to women who smoke.

Younger mums are the least likely to quit when they get pregnant.

This issue's been in the press lately after Stacey Solomon was photographed smoking while pregnant.So what are the dangers? And how big is the risk?

· Miscarriage: Doctors estimate that around 5,000 miscarriages in the UK each year are linked to smoking.

· Still-birth: It is thought that smoking causes a third of still-births and deaths among very young babies, affecting about 300 babies each year.

· Premature & small babies: Smokers are more likely to give birth early and to have lighter babies who may have problems developing as they grow up.

· Deformed limbs have also been linked to smoking.

But there are other reasons why a woman may suffer problems like these during pregnancy and it is often difficult to prove that smoking was the main factor.

Also, in most cases, smokers will give birth to healthy babies who grow up without any problems.

"But just because your mum smoked with you, or even if you've had healthy children yourself while you smoked, that doesn't mean your next pregnancy won't be affected," says Dr Mackenzie.There are other things to think about

· Passive smoking: Even if mum doesn't smoke, other smokers in the house can have an impact on an unborn baby

· Children born to smokers are more likely to smoke themselves when they grow up

· Smoking in the house with a baby increases the risk of cot death

Dr Mackenzie sometimes has to tell young women that smoking may have led to their baby's death.

"We have to be honest. If a woman has a baby who dies, she always blames herself. That's human nature.

"But if there has been a contributing factor like smoking you have to tell them.

"Then you can help them stop smoking for a future pregnancy."

http://www.bbc.co.uk/newsbeat/17430533