Acute Exacerbations

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What is an acute exacerbation?1

An acute exacerbation of chronic obstructive pulmonary disorder (COPD) is a sudden worsening of symptoms of the disease. Acute exacerbations are also called COPD “attacks” or “flare-ups.”

These COPD attacks can be very frightening for the patient, especially because they can happen so suddenly. However, the right kind of treatment can often bring an attack under control fairly quickly.

What are the signs of a COPD attack?2

During a COPD attack, a patient has symptoms that are much worse than usual. These symptoms can include:

  • Feeling short of breath or breathless
  • Coughing
  • Fever
  • Increased amount of mucus
  • Change in color of the mucus: from clear to yellow, green, brown, or red

What causes COPD attacks?3,4

Two common causes of COPD attacks are:

Infections and air pollution trigger COPD attacks by causing the lungs to become irritated and inflamed. However, around 30% of exacerbations have an unknown cause.

Some COPD patients are more likely than others to have COPD attacks, for reasons that are not understood. Patients who have two or more COPD attacks in a single year have a higher risk of having these attacks in the future. COPD patients at an advanced stage of the disease have lungs are less able to fight off infections. So, they are likely to have COPD attacks more often then patients in earlier stages of the disease.

How are COPD attacks treated?2,3,5,6

COPD attacks can have a harmful effect on a COPD patient’s quality of life, particularly if they happen on a regular basis. For this reason, it is crucial for patients to be ready to treat the symptoms of COPD attacks as quickly as possible.

Special kinds of medications called “inhaled bronchodilators” can be useful for immediately treating the symptoms when a COPD attack hits. Healthcare providers should prescribe their COPD patients with the right kind of inhalers to have on hand for treating COPD attacks. Using supplemental oxygen or taking other types of medications called corticosteroids can also help relieve the symptoms of the attack.

If an infection in the respiratory system is causing the COPD attack, then the person usually has symptoms like fever or a change in mucus color. Antibiotics can treat the infection and relieve the symptoms.

If the COPD attack is very severe, then the patient may need to spend time in the hospital to receive treatment. At the hospital, chest x-rays and blood tests help healthcare providers decide the best way to treat the exacerbation. While in the hospital, the patient might be treated with:

  • IV medications and antibiotics
  • Supplemental oxygen
  • Ventilator to help with breathing

COPD attacks can be dangerous – they can even lead to lung failure if they are not treated in the right way. If at-home treatment is not working well enough to relieve the symptoms, then the patient still might find it too difficult to breathe. If that happens, patients should contact their healthcare provider immediately and/or go to the emergency room.

view references
  1. Global Initiative for Chronic Obstructive Lung Disease. Pocket guide to COPD diagnosis, management and prevention. 2014. Available at: www.goldcopd.org [Accessed 21 November 2014.]
  2. American Thoracic Society / European Respiratory Society Task Force. Standards for the Diagnosis and Management of Patients with COPD: Guide for Patients [Internet]. New York: American Thoracic Society;2004 [updated 2005 September 8].
  3. World Health Organization. “COPD Management.” Chronic obstructive pulmonary disease (COPD). Available at: http://www.who.int/respiratory/copd/en/ [Accessed 21 November 2014.]
  4. "Chronic obstructive pulmonary disease.” In: Gibson GJ et al., eds. The European Lung White Book: Respiratory Health and Disease in Europe: European Respiratory Society; 2013:148-159.
  5. Haiken, M. “Caregiver’s guide to Stage III COPD.” Available at: https://www.caring.com/articles/caregivers-guide-to-stage-3-copd [Accessed December 17, 2014.]
  6. Mayo Clinic. “Treatment and drugs.” COPD. Available at: http://www.mayoclinic.org/diseases-conditions/copd/basics/causes/con-20032017 [Accessed 2 December 2014.]
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