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 mucusproduction 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. 1Other 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 ofpneumonia 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. Prevention of COPD Exacerbation
Preventative strategies that may help patients with COPD prevent acute exacerbation include: * Pneumonia and annual flu vaccine (a flu shot can decrease serious illness and death by as much as 50% for patients with COPD). * Handwashing * Balanced diet, sufficient amount of exercise/activity and adequate sleep * Avoiding exposure to environmental irritants such as air pollution (pay attention to air quality alerts), extreme temperatures and cigarette smoke (including secondhand smoke).
* Avoid crowds, especially during cold and flu season Chronic bronchitis. Lung damage and inflammation in the large airways results in chronic bronchitis. Chronic bronchitis is defined in clinical terms as a cough with sputum production on most days for 3 months of a year, for 2 consecutive years. [22] In the airways of the lung, the hallmark of chronic bronchitris is an increased number (hyperplasia) and increased size (hypertrophy) of the goblet cells and mucous glands of the airway. As a result, there is more mucus than usual in the airways, contributing to narrowing of the airways and causing a cough with sputum. Microscopically there is infiltration of the airway walls with inflammatory cells.
Inflammation is followed by scarring and remodeling that thickens the walls and also results in narrowing of the airways. As chronic bronchitis progresses, there is squamous metaplasia (an abnormal change in the tissue lining the inside of the airway) and fibrosis (further thickening and scarring of the airway wall). The consequence of these changes is a limitation of airflow. [23] Patients with advanced COPD that have primarily chronic bronchitis rather than emphysema were commonly referred to as “blue bloaters” because of the bluish color of the skin and lips (cyanosis) seen in them. 24] The hypoxia and fluid retention leads to them being called “Blue Bloaters. ” Emphysema Gross pathology of a lung showing centrilobular-typeemphysema characteristic of smoking. This close-up of the fixed, cut lung surface shows multiple cavities lined by heavy black carbon deposits.
Lung damage and inflammation of the air sacs (alveoli) results in emphysema. Emphysema is defined as enlargement of the air spaces distal to the terminal bronchioles, with destruction of their walls. 22] The destruction of air space walls reduces the surface area available for the exchange of oxygen and carbon dioxideduring breathing. It also reduces the elasticity of the lung itself, which results in a loss of support for the airways that are embedded in the lung. These airways are more likely to collapse causing further limitation to airflow. The effort made by patients suffering from emphysema during exhalation, causes a pink color in their faces, hence the term commonly used to refer to them, “pink puffers”.
