COPD exacerbation

People with chronic obstructive pulmonary disease (COPD), especially those who have chronic bronchitis, may experience a rapid, sometimes sudden, and prolonged worsening of symptoms (cough, amount of mucus, and/or shortness of breath). This is called a COPD exacerbation. These exacerbations often are life-threatening and can lead to hospitalization. With treatment, many people recover and return to the same level of shortness of breath they had before the exacerbation. COPD exacerbations often occur more frequently, last longer, and are more severe the longer you have COPD.

Because a COPD exacerbation can be serious, if you have a sudden worsening in your usual shortness of breath that does not improve after using your medication, have someone take you to the emergency room. Call 911 if necessary.

Cause

The two most common causes of a COPD exacerbation are:¹

• Infection in the airways of the lungs, such as bronchitis, or in the lungs, such as pneumonia. Infections are the most common cause of COPD exacerbations. Infections usually are caused by a virus but can also be caused by bacteria.
• Air pollution.

A COPD exacerbation results in a dramatic increase in mucus production in the lungs or narrowing of the airways of the lungs (bronchial tubes). The increased mucus production and airway narrowing reduce airflow in the lungs, which results in worsening symptoms of cough and shortness of breath.

The cause of about one-third of COPD exacerbations is unknown.¹ Other causes may include heart failure, allergic reactions, the accidental inhalation of food or stomach contents into the lungs, and exposure to temperature changes or chemicals.

Symptoms

The symptoms of a COPD exacerbation are your usual symptoms suddenly getting worse. These include:

• Increased shortness of breath and wheezing.
• Increased cough with or without sputum (mucus), and a change in the color or amount of the sputum.

Fever, insomnia, fatigue, depression, and confusion may also be present.

Treatment

Treatment of a COPD exacerbation depends on its severity. It may involve several visits to your health professional's office or to an outpatient clinic, or it may require you to be treated in the hospital.

A number of medical organizations have developed recommendations for the treatment of COPD exacerbations. These recommendations generally include using:

• Medications that relax the bronchial tubes (bronchodilators) and make it easier to breathe. These medications may include inhaled anticholinergics (such as ipratropium bromide) and beta2-agonists (such as albuterol).
• Oral corticosteroids, which reduce inflammation in the bronchial tubes and may make breathing easier. They are typically given for 5 days to up to 14 days in those who are not already receiving long-term therapy with oral corticosteroids.
• A machine to help you breathe (mechanical ventilation), if you are having severe breathing problems. This is used only if you are not responding to medication.
• Oxygen, to increase the amount of oxygen in your blood.
• Antibiotics, which are often used when a bacterial infection is considered likely. People with COPD have an increased risk of pneumonia and frequent respiratory infections. Although most infections are caused by a virus, some are caused by bacteria. Most studies support the use of antibiotics. But some experts believe that since most exacerbations are caused by viruses, antibiotics should not be used unless there is a demonstrated bacterial infection.

Treatment may also include:

• Intravenous (IV) fluids, to treat dehydration.
• Other bronchodilators, such as intravenous theophylline. These are used only if you are not responding to other treatment.
• Diuretics, which remove water from the body by promoting urine formation, if you are suspected of having heart failure.

Citations

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2005). Executive summary (updated 2005). In Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Available online: http://www.goldcopd.com/GuidelinesResources.asp?I1=2&I2=0.