Exacerbations - My Take!

[filcab]

HI,
You won’t find this in any write-ups, this is just my own personal take on exacerbations.

COPD is defined as "a sustained worsening of the patient's condition, from the stable state and beyond normal day-to-day variations, that is acute in onset and necessitates a change in regular medication in a patient with underlying COPD”. The best we can probably do is to categorize them as mild, moderate and acute. These classifications are my own thoughts, and again are not found in medical books. This is a broad simplification and as such there will be various exceptions.

Mild - These occur at home when you suddenly start coughing up more phlegm and it is a dark yellow or green colour. You may or may not experience more SOB, tightness in the chest, or a sudden drop in SATS. You should call your doctor and set up an appointment and see if he/she wants to start an anti-biotic and/or prednesone regimen. Quite a few of us have anti-biotics and prednisone on hand and we will begin a 10 day home treatment. We will then contact our doctor and let them know what we are doing and the doctor will want to see us at the end of two weeks to check our lungs for clarity. Myself, I would be more inclined to call these flare-ups rather than exacerbations.

Moderate - If you don't have medications at home or if you feel that the home treatment is not working and you are getting worse, then it's time to take a trip to the E/R. At the E/R they will check you over thoroughly, take x-rays to check for pneumonia and probably monitor your heart. You will probably receive several nebulizers of Atrovent and Salbutomol mixed, to try and open your airways and relieve your stress. Usually it is just a viral or bacterial infection that will pass over time (10-14 days) so you will be sent home with anti-biotics and prednisone.

Acute(AECOPD) - This is the Grand Daddy of all exacerbations, where you end up in hospital for 10-12 days. Using myself as an example, twice, when I went to the E/R it was determined that I was in Respiratory Failure, meaning that my CO2 level was way up and my O2 level was down. I was given massive amounts of prednisone via I.V. and pumped with anti-biotics and put on O2. The second time I went I was also put on a CPAP as I could not properly get rid of the CO2 on my own. I was released 12 days later. Was this experience traumatic? Not really! It was certainly uncomfortable but we are uncomfortable most days trying to catch a good breath.

Exacerbations are usually caused by infection(bacterial or viral) or respiratory muscle fatigue - leading to pulmonary acidosis or respiratory failure and underlying heart problems.

What we used to call getting a cold or the flu, we now call having a mild exacerbation. The trick now is not to get paranoid about exacerbations. With proper exercise, nutrition and breathing techniques there is an excellent chance that you will never have an acute exacerbation.

Hope this helps,

Phil

[John]

Thanks Phil

[morningstar]

Phil,

The last two weeks my HR has started to climb again. It is usually 75-78 and lately has been on rest 94-106 Not bad if I am exercising but not sure what is going on. I know the pressure here is way low and that causes SOB but my o2 is staying 96-98 on 2 1/2 liter. Any thoughts o this? No phlem only a stuffed nose. Thanks,

[filcab]

Hi Rosemarie,

I don't know if HR is a factor or not in exacerbations but I will see if I can do a little research and find out. I know my HR usually ends up at around 110 during exacerbations. Whether this is anxiety or not, I don't know. During my last E/R my Sats actually hit 100 a couple of times with my O₂ set at 2l/min.

Phil

[morningstar]

Thanks Phil,

I don't seem to be able to find the two conneted although they do say CHF tends to go with COPD which I also have.

[LindaNY]

This is some great information, Phil.

Thank you.

[ronwtor]

dear phil.had a major exacerbations attack it almost cost me my life.this is how i found out i had c.o.p.d not a good way to find that i had c.o.p.d. april . 2006. i am now finishing rehab and learning to live with it

[Blossom/Jackie W.]

You're right Ron; that's a heck of a way to find out you have COPD though I tend to think this happens with some degree of frequency. On the flip side is having a Major exacerbation, spending 4 days in hospital but not being diagnosed until 5 years later. Even after another overnighter in the ER 2 years after the first stay. That's what happened to me.

It's great you're going to Rehab; I've heard only good things about it. It'll do wonders for you in learning to "living with" and "dealing with" the disease.

Do you live in Canada or the US Ron? If you're in Canada; you're fortunate you got accepted in.