If you have been diagnosed with chronic obstructive pulmonary disease (COPD) for a long time, it is likely you have experienced an exacerbation or flare up. A COPD exacerbation means your respiratory symptoms (breathlessness, coughing, and wheezing) were suddenly escalated to a degree where you might have been obligated to seek emergency medical attention.
Obviously it is best to avoid COPD exacerbations also known as flare ups at all costs, however the nature of COPD makes it difficult to avoid these situations entirely. Simple everyday activities can cause a flare up. Raking leaves and being exposed to seasonal allergies can initiate a sudden reaction in some people. Others will be susceptible to bleach and cleaning products that cause serious respiratory reactions. The bottom line is that everyone is different and everyone’s COPD affects them differently, meaning it is impossible to give someone an indefinite guide into avoiding COPD flare ups entirely.
There are many different practices and healthy habits you can implement into your daily routine in order to reduce the chances of experiencing a flare up, and this is something we will discuss in detail later in this article. First and foremost, it is important to be prepared for when you do experience escalated symptoms.
Having a risk management plan in place will help you to make the right decisions depending on the scenario.
Preparation for COPD flare ups
In this section we are discussing how preparation can make the difference between an uncomfortable yet manageable COPD flare up and hospitalization.
Risk management plan
Developing your own risk management plan can be a useful tool for when scenarios do arise and drastic action must be taken quickly in order to ensure a positive outcome.
Here is a simple outline of a risk management plan that we have filled out for a COPD exacerbation:
1. Identify risks
What are your risks and how likely are they to occur?
COPD poses health risks including having a COPD flare up. A COPD flare up is usually triggered by inflammation in the lungs either due to an infection or irritant that causes this inflammation.
2. Minimize or eliminate risks
Once the risks have been identified you need to either eliminate or minimize those risks.
The most important irritates and infections you should avoid are pneumonia, flu, seasonal allergens, air pollution, smoke. We will discuss details in a later section about how to avoid these irritates and in turn avoid COPD flare ups.
3. Identify who has to do what, should a flare up occur
One of the simplest and most effective tools in managing your COPD flare up is to delegate who has to do what, should your plan have to be enacted.
Make sure to have an emergency contact on your phone who you can count on to drive you to the hospital. You should also have an emergency tool that can notify your caregivers or medical services for you.
4. Determine an action plan with your doctor
Recovery contingencies should be determined by the extent of your flare up.
Which also means you should have a good understanding of how detrimental or minor your flare up is. And while this will come with experience, but there are ways you can track your symptoms and better understand the severity of your symptoms so that you are able to make this distinction during the flare.
Your doctor and you should set up an “action plan” ; it should outline specific actions, doses, or medications to manage a flare up. For example, they might prescribe for you to increase your oxygen flow setting while you are experiencing the flare up, or they might prescribe an emergency inhaler that will give you a dose of fast-acting steroids.
If your exacerbation is severe enough to seek emergency medical care, you should be aware of the urgent care in your locale. You should have your medical history written down in your phone or on your person (a piece of paper in your wallet, or attached to your portable oxygen concentrator carrying case) to give to medical responders so they are updated about you and your condition.
If you are allergic to any medication or have had any reactions to medical treatments in the past, you can make sure to have this written down so if you are having trouble breathing, you don’t have to try and talk with the emergency responder too much.
5. Communicate the plan to all the people it refers to
Make sure you tell everyone in your circle what to expect should they need to help you through a COPD flare up.
You can also work together to understand your symptoms better so that you and your caregivers feel confident managing minor flare ups, and you understand when you must seek medical attention.
Now that you have a risk management plan, you must be able to recognize the symptoms of a COPD flare up.
Recognizing escalated COPD symptoms
During a COPD exacerbation, airways become restricted and your lung function quickly and dramatically declines. Suddenly, you may experience more mucus clogging your airways, or the muscles in your respiratory tract constrict significantly, cutting off your air supply.
Symptoms of a COPD flare are:
- Breathlessness or shortness of breath. If you are gasping for air, and neither oxygen nor medication are relieving your breathlessness, seeking medical attention is the right thing to do.
- Increase in coughing attacks. Coughing helps to rid your lungs and airways of mucus blockages and irritants and while coughing is a normal and useful reaction for COPD patients, if it is persistent to the point where you feel discomfort for a long period of time, call your doctor right away.
- Wheezing. Hearing a wheeze or whistling noise when you breathe means that air is being forced through a narrower passageway, if your airways are swelling or built up mucus cannot be cleared, breathing will become nearly impossible and medical attention will be necessary should your medications and oxygen therapy prove useless.
- Increase of mucus. You may begin to cough up more mucus than normal, and it may be a different color than usual. Mucus that is clear or a slight yellow color is normal, but if it is a dark green, dark brown, or dark red color you should call your doctor right away.
- Fatigue or sleep problems. Sleep disturbances or exhaustion can indicate less oxygen is getting to your lungs and through your body and can be an indicator or exacerbated COPD symptoms
- Cognitive impairment. Confusion, slow thought processing, depression, or memory lapses can mean your brain isn’t receiving enough oxygen. This is a huge indication of severe COPD symptoms, so call your doctor right away.
Creating an action plan for a COPD flare up
If you are experiencing a COPD flare up, there are a few steps you can take in order to treat your symptoms on your own rather than immediately calling for emergency care. Understanding and managing COPD symptoms means that you have to be confident enough to know how and when to utilize certain medications and strategies. Having an extensive conversation with your doctor about these measures is very important, you can also learn a lot about COPD flare up preparedness in a pulmonary rehabilitation course.
During a flare up it is important to try to stay calm to minimize your symptoms, anxiety can initiate added breathlessness that will only make your situation worse. But if you feel overwhelmed, reach out for help right away.
1. Use a quick-acting inhaler
Rescue inhalers work by sending a powerful stream of medicine straight to your constricted lungs. This is different from your normal short-acting bronchodilators inhaler that will give you medication that takes longer to initiate but lasts longer in your system. A fast-acting relief inhaler helps to relax the tissues in your airways quickly, letting you breathe easier right away and it wheres off shortly after.
2. Take oral corticosteroids to reduce inflammation
Corticosteroids may already be a part of your treatment plan that you have set up with your doctor. They reduce swelling and may help to widen your airways to let more air in and out of your lungs so if you don’t already take corticosteroids your doctor may prescribe them for a period of time after you have a flare up to help get your inflammation under control.
3. Use a form of oxygen therapy to get more oxygen into your body
If you use supplemental oxygen at home, you may want to take advantage of your extra oxygen supply supply during a flare up. If you have a portable oxygen concentrator (POC), your normal flow setting should be much lower than the device's full capabilities. If you experience a flare up, your normal oxygen output may need to be increased to a higher dosage of oxygen, this is why your POC should be capable of operating at a higher output than your prescribed level.
Increasing you oxygen supply during a flare up is something you will discuss with your doctor when they prescribe you oxygen therapy. It should also be outlined again in your action plan for when you experience a COPD flare.
(4.) Seek emergency care, should steps 1-3 not prove useful
In some severe instances, your rescue medication, anti-inflammatory steroids, and oxygen therapy won’t bring your exacerbation symptoms back down to a manageable level, in which case you may need mechanical intervention.
If you notice that your at-home action plan isn’t bringing you relief or if any of your symptoms begin to get worse, it is time to reach out for help. Call an ambulance, or have a caregiver make the call for you. Once you arrive at the hospital, you may need machine intervention like theophylline to help bring your symptoms under control. In these cases, it is not abnormal to also need an IV to rehydrate your body, as well as antibiotics to prevent respiratory infections like pneumonia.
Fortunately, most people recover their breathing after taking steps 1 -3 to get their their symptoms under control.
You can also work towards creating healthy habits and lifestyle changes that will help you to avoid these situations as much as possible. Reducing the chance of experiencing a COPD flare up are simple best practices, and will help you to lead a healthy and long life with COPD.
Preparation can make the difference between an uncomfortable yet manageable COPD flare ups and severe flare ups that require hospitalization. Prevention can help you to avoid COPD flares in the first place, by reducing the likelihood of experiencing exacerbated COPD symptoms.
Avoiding COPD flare ups
About 33 percent of COPD exacerbations don’t have a known cause, which is why the preparation section of this article is so important, because no matter how well you work to prevent COPD exacerbations, sometimes there are unforeseeable implications that will affect your respiratory system.
Oxygen therapy is administered at home for at least 15 hour a day. Pulmonary patients can use oxygen devices like a liquid oxygen tanks, gas oxygen tanks, or portable oxygen concentrators. Portable oxygen concentrators costs the most up front, but in the long term offer the most savings because you never have to pay to refill the device as you would with a tank or canister.
Each year, approximately 1.5 million patients in the United States receive long term oxygen therapy (LTOT). LTOT improves survival rates and increases the quality of life in hypoxemic patients with COPD. Staying connected to your oxygen device and using the therapy as instructed by your doctor will help to prevent breathlessness and reduce stress on your lungs.
Oxygen therapy relieves serious COPD symptoms and can help you get back to a normal and healthy daily routine in other important facets of your life.
Avoid exposure to lung irritants
You can start by cleaning your home and ridding your living space of irritates such as kerosene heaters. If you can, dust often and vacuum carpets daily. Dust and dust mites will cause irritation in anyone’s lung but it is extremely harmful if you have COPD.
When you are cleaning surfaces avoid harsh chemical cleaning products and opt for natural disinfectant and cleaning products such as lemon water, vinegar, baking soda.
You should also keep the humidity at a manageable level. You can do this by always turning on a fan or ventilation system while you shower and taking less hot showers.
Do not smoke, and try to avoid secondhand smoke. Smoking is one of the worst habits you can continue to entertain after being diagnosed with COPD. Smoke is one of the most invasive and harmful irritates you can breath into your lungs, and you will inevitably experience more serious flare ups if you continue to smoke.
Air pollution is another irritate that can impact your lungs and cause flare ups. While the state of outdoor air quality is largely out of your control, you can invest in an air filtration system for inside your home. If you monitor the outdoor air quality daily you can be aware of when it is safe and when you should avoid going outdoors.
Avoid getting the common cold or flu
As you are probably aware of, it is best to avoid large crowds during cold and flu season to prevent getting sick. It is especially important now, during the global pandemic with the novel coronavirus causing COVID-19 still posing a serious threat to our population as a whole, and it is increasingly worrisome for respiratory and autoimmune patients.
COPD flare ups are mainly caused by respiratory viruses (like the coronavirus) and other bacteria which causes increased inflammation and chest infections and adults with COPD or asthma are more likely to catch the flu.
There are two annual vaccinations recommended for patients with COPD and research has shown that these vaccination can reduce the number of exacerbations and subsequently reduce hospital admissions:
- Influenza (flu) vaccine.
- Pneumococcal vaccine.
Also consistently wash your hands and use hand sanitizer to prevent the spread of germs, especially when the weather gets colder during flu season.
Monitor mucus production
You want to clear your airways of mucus daily. You can do this by using productive coughing techniques to bring up mucus and drinking plenty of fluids in order to thin out the mucus that is already in your system. By not clearing your airways, mucus will build up and become too thick to clear on your own, causing uncomfortable breathing complications.
See your doctor regularly
Keep regular appointments with your healthcare provider, such as your pulmonologist is so good for you and keeping you COPD under control. While you may be capable of monitoring your symptoms on your own, it is always good to have a health professional's opinion. They may suggest a new treatment, or give you the motivation to stay on track with your current treatment plan.
Practice healthy habits
Practicing healthy habits is just about the best thing you can do to treat COPD and avoid flare ups. While healthy habits seems easy on paper, actually getting into the rhythm can be a challenge.
Getting enough sleep at night and eating a healthy diet, getting a pneumonia or flu shot when your healthcare provider recommends, quitting smoking and avoiding secondhand smoke are some of the many habits you can work towards in your daily life. You can also start an exercise program that you either do on your own, or take part in a pulmonary rehabilitation course in your local area.
Here are some of our favorite articles to share with our readers about different healthy habits to take better care of your COPD:
We hope that you have gathered some useful information about how to create a risk management plan, establish an action plan, and how to avoid flare ups or at least reduce the chances of experiencing a serious one.
While it could be argued that focusing on preventing a COPD flare up is the most beneficial for a COPD patient, some flare ups are caused for no apparent reason. So while working on creating healthy habits and a lifestyle to avoid flare ups is important, you should also focus on preparedness. Having an actionable plan to address severe COPD symptoms should they occur is crucial.