How to Avoid COPD Exacerbations/Flare-Ups
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Thomas DeMarini, MD PulmonologistThe problem with COPD is you have obstruction to air flow, so most patients have a chronic cough, have some shortness of breath, have some wheezing. And periodically they will have what we call an exacerbation, which is an acute worsening of the disease. So their cough will get worse, their shortness of breath will get worse,
Thomas DeMarini, MD conttheir mucus production will get worse. These can be due to just the disease. They can also be due to an infection -- either a viral or bacterial infection. And the patients just get worse. COPD flare-ups to us are extremely serious because they are a marker that you are going to lose lung function.
Thomas DeMarini, MD contIn other words, each exacerbation makes your lungs a little bit worse. So when a patient comes to me who is diagnosed with COPD, my first issue is to get them off inciting experiences such as, smoking is the big one, but exposure to dust, chemicals, smoke fumes, non-specific respiratory irritants of all kind.
Thomas DeMarini, MD contAnd once I reduce that source exposure, then my next thrust is to keep them from having exacerbations of their disease. What I usually tell patients to look for in a flare-up is: Is their mucus getting worse? Is there more of it? Is it changing color? Is it going from its usual pale white to a yellow or green sputum?
Thomas DeMarini, MD contIs their cough getting worse? Are they having more coughing when they lay down? I also warn them that if they are having a fever, that’s usually a sign that you’re about to have an exacerbation. With some of our patients we use a little device called a peak flow meter that they can blow in every morning
Thomas DeMarini, MD contand see what their lung function looks like. And if that starts to fall down to 150 over several days, that’s a certain sign they’re going to have an exacerbation. But usually I tell the patients they will know when they’re sick. The number one thing that you can do is avoid irritants,
Thomas DeMarini, MD contand that specifically means you need to come off cigarettes. And the physician can assist you with that. I also tell patients if you’re in a dusty occupation, you need to do what you can to avoid that dust and avoid the irritants. And then, it’s been shown repeatedly that gentle exercise, aerobic exercise,
Thomas DeMarini, MD contsignificantly improve patients' breathing and decreases the exacerbations. And there are a host of medications we can use now that barely existed or didn’t exist at all 25 years ago that really improve the day-to-day function of patients with COPD so they can do the things that they want to do. That part of the treatment of the patient is highly individual
Thomas DeMarini, MD contand that’s why most people who have severe disease end up at a lung specialist for us to be able to institute those medications.