An exacerbation, or "flare-up," can look different for different people, like coughing fits, extreme tiredness, or fever. Practicing good health habits can help prevent flare-ups in the first place. But when you have a flare-up, it's important to get treated right away. In this episode, we'll answer questions like: what is the difference between a flare up and a "bad day"? How can you create a plan with your care team? And what can loved ones do to help?
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[00:00:02] Jan Cotton: My first flare up was around 2007, 2008.
[00:00:06] Micaela Arneson: A flare-up is also known as an exacerbation. If you've been following along with our series, you'll have heard them mentioned already. If not, we recommend you start from episode one.
[00:00:16] Jan Cotton: Oh my goodness, a flare up has got to be one of the worst things in the world. It is the most debilitating feeling one can ever have. You can't get from one step to the next without trying to catch your breath.
[00:00:30] Micaela Arneson: The bad news is that flare ups aren't entirely preventable. People with chronic obstructive pulmonary disease or COPD, can expect to experience them at least a few times in their life. But the good news is they can be treated and there are things you can do to reduce their severity and frequency. So in this episode, we'll talk about all things exacerbations. What they look like, what can be done about them and what to expect if one lands you in the hospital.
[00:00:59] Jan Cotton: I have a 24-hour period. If I can't get my body opened and my airways opened in 24 hours, it's time to go to the hospital.
[00:01:09] Micaela Arneson: This is the COPD Podcast. I'm your host, Micaela Arneson.
[00:01:17] Mike Hess: A COPD exacerbation is any kind of flare up that's above your baseline symptoms.
[00:01:23] Micaela Arneson: Mike Hess is a respiratory therapist. Exacerbations are usually caused by lung infections, which can be triggered by germs, viruses, and other irritants.
[00:01:33] Mike Hess: One of those big triggers is getting a cold or flu or pneumonia. There are a lot of people who are sensitive to certain allergens, pollens, fumes, perfume, things like changes in barometric pressure or humidity.
[00:01:47] Micaela Arneson: And of course, smoke particles and other pollutants can trigger lung infections, which is just one reason why people with COPD shouldn't smoke and should avoid situations where others are smoking. So what does an exacerbation look like?
[00:01:59] Mike Hess: It could be an increase in how often you're coughing. It could be an increase in how much you're bringing up, increase in shortness of breath or reduced activity tolerance.
[00:02:09] Jan Cotton: I wheeze because I have an asthma component to my COPD. It's almost like if you're trying to get air sucked through a straw.
[00:02:18] Micaela Arneson: Because people experience COPD differently, there's a range of symptoms that can signal a flare up. And for some people, like Jean Rommes, symptoms can even change from episode to episode.
[00:02:29] Jean Rommes: It is a real spectrum for me anyway. Mine can be as simple as I'm going to cough more than I usually do. If all of a sudden I'm starting to cough and I can feel that post nasal drip just sort of going right down the back of your throat. Those things lead up to the change in the color of the mucus. And sometimes that's also accompanied by the fact that I need a little more oxygen than I usually do. I had one where I ran a low grade temperature for 12 days in a row.
[00:03:00] Mike Hess: Each exacerbation can look a little bit different. Listen to your body, listen to your gut instinct, don't be concerned about being the person that cries wolf. The earlier we catch a lot of these things, the easier they are to treat.
[00:03:12] Micaela Arneson: Now there are a few dangerous warning signs, which should prompt you to call emergency services immediately. These include confusion, disorientation, slurring of speech, blue color in lips or fingers, chest pain, or shortness of breath so severe that you can't talk. But as Mike said, if you're at all concerned or have any questions, talk to your qualified healthcare provider and don't rely on what you hear on this podcast. This podcast is for educational purposes only. It is not a substitute for formal medical advice, diagnosis, or treatment.
[00:03:51] Dr. David Mannino: If you sort of look across our population of COPD patients, some are more likely to have exacerbations, others are not.
[00:03:59] Micaela Arneson: That's Dr. David Mannino, a pulmonologist. He says that while no one is immune to flare ups, some people seem to have more of them than others. It's not totally clear why, but one thing is for sure.
[00:04:11] Dr. David Mannino: Certainly one of the biggest predictors of future exacerbations is a history of recent exacerbations. That's why we tend to treat these more aggressively.
[00:04:22] Micaela Arneson: Aggressive treatment is important because flare ups can have a cumulative impact and reduce lung function over time. We talked about medications with another pulmonologist, Dr. Mina Pirzadeh.
[00:04:32] Dr. Mina Pirzadeh: Inhalers and oral medications are generally the mainstay of therapy. The other medications that we use that aren't inhalers are trying to reduce exacerbations. One of them is meant for people who have more than two flares per year, but also have chronic phlegm production. They take an oral pill every day. The other medication is actually an antibiotic, but we use it for its anti-inflammatory effects, and that's generally taken as a pill three times a week.
[00:05:05] Micaela Arneson: It's important that people coordinate with their care team about what treatment is right for them.
[00:05:09] Mike Hess: Everybody should be speaking with their clinician about what to do in case of exacerbation. Sometimes people will get a little kit that may have some antibiotics, steroids, extra inhaler medication, or nebulizer medication, and have a plan to use those.
[00:05:24] Jean Rommes: I've got an arrangement with my doc. He makes sure that I have antibiotics at home. If something happens and the color of the mucus that I cough up changes color, that's when I start an antibiotic. And that's also when I call his office, I explain exactly what's going on. I tell him exactly what I'm doing about it. And my question always is, is there something more you want me to do?
[00:05:50] Micaela Arneson: There are also proactive steps people can take to make sure they don't get too sick too often.
[00:05:55] Dr. Mina Pirzadeh: We really try and emphasize a healthy lifestyle, take all the precautionary measures to stay healthy, having good hand hygiene, wearing a mask if you're in public places.
[00:06:07] Mike Hess: Try to avoid any of your triggers. Annual vaccinations are an essential part of trying to avoid exacerbations.
[00:06:14] Micaela Arneson: And of course, a balanced diet, regular exercise, mental wellness, and good adherence to medication are all important to living a healthy lifestyle. A simple, easy way to keep track of medications, as well as changes in condition and what to do in the event of an exacerbation, is the My COPD Action Plan, which is a free document from the COPD Foundation. Jean recommends it.
[00:06:36] Jean Rommes: Having that written plan for most patients, I think, is really, really critical. Many patients haven't really thought about what preceded their exacerbation. What were the things, what were the red flags that they should have seen? Because you have to go back and think about that. The reason it's so important to know what those red flags are, is that you do not want to get really, really, really sick.
[00:07:05] Mike Hess: Sometimes if it does get bad enough, you end up having to head to the hospital.
[00:07:09] Micaela Arneson: Going to the hospital with an exacerbation can mean a few different things. Some people are given a new course of treatment and sent home to rest and recover. Others may need to stay overnight or for a few days for extra care, sometimes from respiratory therapists like Mike.
[00:07:24] Mike Hess: The birthplace of respiratory therapy was really the polio epidemic, where we were helping folks who were stuck in the iron lungs, making sure that they were breathing properly. And then we eventually grew into a lot of other therapies, providing oxygen to folks throughout the hospital, nebulizer medications, eventually mechanical ventilators, where you might have the tube down your throat and the machine helping you breathe.
[00:07:43] Micaela Arneson: Oxygen therapy gives people who are struggling to breathe a little extra oxygen and is commonly prescribed to treat an exacerbation. We talked about it in episode four on oxygen therapy and other interventions with Dr. Mina Pirzadeh. So you can always go back and re-listen to that to refresh your memory.
So let's fast forward to when you're feeling better and ready to go home. What's next?
[00:08:09] Jean Rommes: For many people, they go in the hospital and they've got a routine of medications that they're using and the hospital puts them on something else. Maybe the same medications, but a different manufacturer.
[00:08:21] Micaela Arneson: Jean has made this transition from hospital to home before, and she and other people with COPD are advised to make sure they understand any changes to their medication regimen and schedule a follow up visit with their primary care provider, and ideally a pulmonologist, too.
[00:08:35] Jean Rommes: I was lucky enough that the person I dealt with in the hospital was the doctor that I'd been dealing with all along. Now, that doesn't happen as much anymore, you're dealing with hospitalists. So part of what they're going to tell you is call your doctor and make an appointment.
[00:08:48] Micaela Arneson: Ensuring that you and the members of your care team are on the same page is important for COPD management generally, and particularly after an exacerbation. But if you're feeling overwhelmed, know that you don't have to face these changes alone. Loved ones and caregivers are a great resource, as are medical staff like respiratory therapist Stephanie Williams.
[00:09:07] Stephanie Williams: Now, a lot of hospitals have transition teams that will help the person get all the equipment they need at home, teach them how to use their medications, when to use their medications, how to utilize oxygen and manage their COPD so that they don't end up coming right back to the hospital with another flare up.
[00:09:26] Micaela Arneson: And if you love someone with COPD and are feeling anxious or fearful about their condition, hospital transition teams and other health professionals are there to help you too.
[00:09:36] Stephanie Williams: If you recognize in yourself that you can't do it all, what a brave thing to say. Caregivers do bear a lot of responsibility and a lot of stress and they need somewhere where they can also share those feelings. There's no shame in getting help.
[00:09:52] Micaela Arneson: Support groups like COPD360social, which is run by the COPD Foundation, are open to anyone affected by COPD to talk about anything related to lung disease. More information about hospitalization and making the transition back home, including a list of helpful questions to ask your hospitalists and other providers, can also be found on the COPD Foundation's website. You can also access the My COPD Action Plan there. If you want to learn more about flare ups, WebMD and Healthline are trusted resources. Links to these sites and more are on our website, healthunmuted.com/resources.
This is the COPD Podcast hosted by me, Micaela Arneson. This show is part of the Health UNMUTED audio library by Mission Based Media and was created in collaboration with the COPD Foundation. To listen and learn more, visit healthunmuted.com and follow our show on your favorite podcast player.