COPD by Donald A. Mahler

Author:Donald A. Mahler
Language: eng
Format: epub
Publisher: Johns Hopkins University Press
Published: 2022-10-15T00:00:00+00:00

Key Points

~A COPD flare-up is a worsening of symptoms, particularly more breathing difficulty, frequent coughing, and coughing up more mucus, which may be yellow or green in color.

~The best predictor of whether you will have another flare-up is the number that you had in the past year:

Low risk: zero to one treated as an outpatient

High risk: two or more treated as outpatient or one leading to hospitalization

~Seventy to eighty percent of flare-ups are due to a chest infection (bacterial or viral), while the remainder are due to environmental conditions, especially air pollution.

~COPD flare-ups can lead to inflammation (redness and swelling) not only in the airways but also throughout the body. One of the primary adverse effects of this systemic inflammation is muscle weakness.

~Even a single exacerbation can cause an accelerated (faster than expected) worsening in lung function.

~Treatment of a COPD flare-up usually includes frequent use of inhaled short-acting bronchodilators (with a pressurized metered-dose inhaler or nebulizer), antibiotics, and/or corticosteroids like prednisone.

~Several medications are approved by the FDA to reduce the risk of an exacerbation, or flare-up, of COPD.

~A written action plan is important in case of a flare-up of COPD.

In the hospital, Molly was treated with oxygen, bronchodilators in a nebulizer every four hours, an antibiotic, and corticosteroids. Her COVID-19 test was negative. She gradually felt better and was discharged after three nights in the hospital. The hospitalist prescribed additional days of the antibiotic and prednisone along with the same inhalers that Molly was using when she was admitted. Her oxygen level improved to 92% at discharge, and she did not require oxygen therapy at home.

Molly had an appointment with a pulmonary physician two weeks later. The doctor reviewed the hospital records including Molly’s current therapies for COPD. He informed Molly that because her recent flare-up was severe enough to require hospitalization, she was now at high risk for another exacerbation. The doctor described the available inhaled medications to reduce the risk of another flare-up and recommended starting inhaled “triple therapy” with a combination of two different bronchodilators and an inhaled corticosteroid. He stated that studies have shown that triple therapy is superior to inhalers with a combination of two medications. The pulmonary physician also suggested that Molly start pulmonary rehabilitation at the community hospital to improve her exercise capacity and to also reduce the chances of another flare-up. Molly felt optimistic that these treatments were going to help her.

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