If you suffer from chronic obstructive pulmonary disease (COPD), you are likely familiar with exacerbations. These are sudden attacks where respiratory and coughing symptoms worsen and persist. Without proper treatment, you could end up in the hospital. Left untreated, exacerbations can lead to hospitalization and potentially death.
However, by taking measures to address symptoms early and find ways to minimize triggers, you can drastically reduce the risk of disease exacerbations, according to Dr. David Mannino, Chair of the Department of Preventive Medicine and Environmental Health at the University of Kentucky.
Follow these tips:
Get to know the symptoms. Some signs of a COPD exacerbation may be obvious: shortness of breath, wheezing, increased coughing, or a cough with additional mucus. You may also experience a fever. But sometimes, the initial signs can be as subtle as fatigue or sleep disturbances.
„Many of my patients with severe COPD simply say they don’t feel like themselves for a few days before more severe symptoms appear,“ says Mannino. It is crucial to pay attention to this. Call your doctor and ask if your treatment plan needs to be adjusted – even if you don’t have more obvious respiratory symptoms.
Stay up to date on your vaccinations. The most common cause of a COPD exacerbation is an upper respiratory infection like a cold, flu, or COVID-19.
„People with COPD are at higher risk for complications with all three,“ says Mannino. That’s why he advises his patients to get all vaccinations. A 2019 study found that people with COPD who received a flu vaccine had nearly a 40% lower risk of being hospitalized for flu-related complications. You should also get both the pneumococcal vaccines PCV13 and PPSV23, as well as the COVID-19 vaccine and booster. And make sure you are up to date on your Tdap vaccine, which protects you against pertussis (also known as whooping cough), emphasizes Mannino.
„A silver lining of the COVID-19 pandemic was that due to masking and social distancing, we saw fewer disease exacerbations in our patients,“ says Mannino. Both reduce the likelihood of catching respiratory viruses. „Historically, January, after the holiday season, is the most common time for exacerbations,“ he explains. „Patients gather with family, leading to a variety of viral and bacterial infections. That’s why I can still recommend to my COPD patients to continue to mask up, at least during cold and flu season.“
Avoid common triggers. Viruses and bacteria account for about 80% of COPD exacerbations, but environmental triggers like cigarette smoke and air pollution make up the remaining 20%, says Mannino. You should:
- Quit smoking and avoid secondhand smoke. „Unfortunately, some of my patients have quit smoking, but still live with someone who smokes,“ says Mannino. „I explain to them that even if their housemate smokes in the garage, smoke can seep into the house.“ Studies suggest that people with COPD living with a smoker or otherwise exposed to secondhand smoke have more respiratory symptoms and worse outcomes than those who do not. It is safest for loved ones to quit altogether.
- Avoid air pollution. It’s harmful to everyone but particularly detrimental to people with COPD, says Mannino. Plan to stay indoors on high air pollution days. Keep your windows closed and the air conditioning on.
- Be cautious with household cleaners. Use less toxic, natural cleaning products when possible and always wear a mask when using them. Also, avoid activities like carpet shaking, vacuuming, or dusting as they can stir up dust that may trigger flare-ups in some patients.
Keep track of all your medications. „When we talk about controlling COPD, it’s very different from how we talk about another common lung disease, asthma,“ says Mannino. With asthma, the goal is for people to be symptom-free. But „COPD is less definitive because most patients have symptoms, given that there is usually permanent lung damage.“ That’s why our goal is for them to maintain a sufficient level of functionality so they can continue doing most of the things they want to do.“
One thing that often confuses COPD patients is that some of the medications they take may not necessarily make breathing easier. „If they take an inhaled steroid or antibiotic a few days a week, it doesn’t improve symptoms, but it should reduce the risk of exacerbations,“ says Mannino. Research shows, for example, that patients taking an antibiotic daily reduce the risk of an exacerbation by 20%. „It’s essential to take all medications prescribed by your doctor, even if they don’t make you feel better,“ he adds. If you have questions about why you need to take something, ask your doctor why.
Develop an emergency treatment plan. It is crucial to call your doctor immediately if you have an exacerbation. „If your symptoms are mild, you may need to adjust your current treatment: for example, use your inhaler twice a day instead of just once,“ says Mannino. They may also prescribe an oral steroid or antibiotic. However, if your symptoms do not go away or worsen – if your oxygen level drops below 92% or your lips and fingertips turn blue – you may need to be hospitalized.
Most exacerbations resolve on their own or in the hospital in about a week. However, many people are unaware that it can take between 8 and 12 weeks to fully recover from an exacerbation. Additionally, there is a higher risk of heart complications, especially if you have been in the hospital.
„That’s why it’s even more important to try to limit your exacerbations or get prompt treatment to minimize future issues,“ says Mannino.