Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it harder to breathe. Your symptoms sometimes become much worse in an episode known as a flare-up, or exacerbation. This might happen because you’ve got a virus or infection. Air pollution and allergies can also cause flare-ups.
If you have a flare-up, you might need treatment in a hospital. An especially serious flare-up could involve a condition called acute respiratory failure, in which you’re very short of breath.
Because your lungs don’t work right during a flare, you’re not able to take in oxygen and breathe out carbon dioxide in the right proportions.
If your symptoms are serious enough, you and your loved ones may have to decide whether you should get mechanical help to breathe. This involves tracheal intubation and a ventilator.
How It Works
Your doctor will probably try other ways to help you breathe first. If your symptoms don’t improve within a certain amount of time -- one hour is a common guideline -- intubation and mechanical ventilation will be the next treatment offered.
You’ll have a breathing tube (also called a tracheal tube) put into your mouth and down into your windpipe (trachea). Then the tube is connected to the ventilator, a machine that pushes air into your lungs.
You’ll get medicine to ease your discomfort.
While the machine keeps you breathing, your respiratory system -- which has been struggling to work very hard -- can rest. Doctors also will do tests to identify and treat any other problems, such as pneumonia, that caused the flare-up.
What to Consider
Intubation and mechanical ventilation can be lifesaving. But know that during this treatment:
- You won’t be able to talk.
- You will need a tube or IV to get nutrition, and you won’t be able to move much.
- Medications may make you sleepy.
- It may be hard to rest.
- You may feel as though you are gagging.
- You may be anxious.
As with any medical procedure, complications can happen. These include:
- Lung infection
- Damage to your lungs
- Damage to your throat
- Bleeding in your stomach
Coming Off the Ventilator
The process of starting to breathe without the ventilator’s help is called “weaning.” When your condition has improved, your health care team will start tests to see whether you can breathe easily on your own without the ventilator. These are also called weaning trials and spontaneous breathing tests.
If you do well enough on the tests, your breathing tube will be removed so you can breathe on your own. Doctors call that “extubation.”
Sometimes, people with COPD can’t wean from the ventilator. They will typically remain in the hospital, rehabilitation center, or extended care facility for the rest of their lives. It can be hard for doctors to predict how you will fare after intubation and mechanical ventilation, both in terms of the length and quality of your life.
You can’t know when a flare-up will happen or how it will affect you. But there is something you can do to prepare for that situation.
Advance Directive, Health Care Proxy
The best time to consider whether you would ever want to be intubated and on a ventilator is before the need arises. Flare-ups can bring a lot of anxiety and confusion, which can make it hard to make big decisions.
Talk with your doctor and loved ones about what kinds of treatments you want in an emergency. It’s wise to put those choices in a legal document called an advance directive, which includes naming someone you trust to make your medical decisions if you can’t communicate. That person is called a health care proxy, and it can be anyone you choose.
If you decide you don’t want intubation and mechanical ventilation, your advance directive can note that.