Chronic obstructive pulmonary disease (COPD) is a long-term lung condition that progressively makes breathing harder. COPD encompasses diseases like emphysema and chronic bronchitis, causing persistent airflow blockage. These conditions lead to chronic symptoms like shortness of breath, cough, and sputum production.
An acute exacerbation of COPD is a sudden worsening of typical symptoms, lasting days. Individuals experience increased breathing difficulty and sputum production. These flare-ups impact quality of life, potentially reducing lung function or requiring hospitalization.
Causes and Triggers of an Exacerbation
Exacerbations often stem from respiratory infections. These infections are commonly viral (e.g., common cold, flu, COVID-19) or bacterial. They inflame airways, increasing swelling and mucus, which restricts airflow.
Environmental factors also provoke exacerbations. Exposure to air pollution, dust, chemical fumes, or smoke irritates sensitive airways. Weather changes, like temperature drops, are also linked to flare-ups.
Other risk factors include not adhering to prescribed daily maintenance medications. Skipping treatments worsens lung inflammation and narrowing, making airways more susceptible. A healthful lifestyle, including sufficient rest, also influences susceptibility.
Recognizing the Symptoms
Recognizing exacerbation signs is important for timely intervention. Primary indicators include increased dyspnea, a worsening of shortness of breath beyond usual. This breathlessness may feel more intense or occur with less exertion.
Another symptom is increased sputum (phlegm) volume. Individuals may cough up more mucus than usual. A change in sputum purulence is also a sign, meaning phlegm becomes thicker and changes color, often yellow, green, or tan.
Other common symptoms include increased wheezing, chest tightness, increased fatigue, and a persistent cough. Individuals might also experience shallow and rapid breathing. In severe cases, confusion or drowsiness can develop, signaling a serious exacerbation requiring immediate medical attention.
Immediate Management and Medical Treatments
Managing an acute COPD exacerbation begins with immediate at-home actions based on a personalized COPD Action Plan. Developed with a healthcare provider, this plan outlines steps for worsening symptoms. A frequent initial step is increasing short-acting rescue inhalers (bronchodilators), which quickly relax airway muscles to improve airflow.
Knowing when to seek emergency medical help is important. Individuals should contact their doctor or go to an emergency department if symptoms are severe, rescue inhaler provides no relief, or if they experience confusion, severe respiratory distress, or bluish discoloration of lips or fingernails. Hospitalization may be necessary for severe exacerbations, accounting for over 700,000 annual admissions in the United States.
Medical professionals may administer several treatments. Systemic corticosteroids (oral or intravenous) reduce airway inflammation and swelling. If a bacterial infection is suspected (often by increased sputum purulence), antibiotics will be prescribed. Supplemental oxygen therapy ensures adequate oxygen levels, especially if breathing is severely impaired. In the hospital, patients may also receive nebulized bronchodilators, deep vein thrombosis prophylaxis if immobilized, and physiotherapy for sputum clearance.
Strategies for Prevention
Proactive strategies reduce the frequency and severity of future COPD exacerbations. Strict adherence to prescribed maintenance medications, particularly long-acting inhalers, is a foundational measure. These help manage underlying lung inflammation and keep airways open consistently. Regular use significantly stabilizes lung function and decreases susceptibility to flare-ups.
Recommended vaccinations offer protection against common infectious triggers. This includes an annual flu shot, as influenza can worsen COPD symptoms and trigger exacerbations. Pneumococcal vaccines, protecting against certain pneumonia types, are also recommended to reduce bacterial lung infection risk.
Smoking cessation is the most impactful lifestyle change for improving lung health and reducing exacerbation risk. Quitting smoking helps repair lung damage and slows disease progression, making airways less vulnerable. Pulmonary rehabilitation programs also provide benefits, offering structured exercise, education, and breathing techniques that enhance lung function and overall well-being. Avoiding known personal triggers, such as allergens or irritants in the home or workplace, further helps reduce exacerbation likelihood.