EXACERBATIONS
On this page, John describes his experience of exacerbations so clearly we have left his text as it was, minor editing excepted. It is one of the most important sections in this website. We should mention that because his FEV1 percentage level became so low, he had to be ultra cautious and careful in protecting himself from infections.
"When I was first diagnosed with COPD, I asked about what exactly was meant by an exacerbation. I asked how I can tell it from say a common cold. The consultant replied that it was a good question. It is.
An official definition of an exacerbation might be when the symptoms of a disease, in this case COPD, worsen i.e. differ from the day to day usual variations, if any. Many types of exacerbation are due to an infection of some sort - remember that if you have COPD your lungs become your weak spot, your 'achilles heel' as my doctor puts it and will be more easily affected than normal.
So what do I look out for?
Well if my breathlessness worsened say over a day or two I might get alarmed. Often when this has happened I have just used more of my inhalers and as often or not it has improved again. It might have been hot or cold or changeable weather that brought on the increased breathlessness, a dusty atmosphere, a poor night's sleep. On the other hand I am aware that it might lead to worse symptoms.
What are these other symptoms?
Well most of us cough up phlegm from time to time and it is usually clear or opaque or cloudy white, maybe greyish. This doesn't worry me but if I start coughing up much more phlegm than usual that is a danger sign. I immediately look at the colour of that phlegm and if it changes to yellow or green then I know it's an exacerbation . Phlegm is usually defined as having arisen from the respiratory system (lung, bronchial tubes) & it is usually coughed up. Often when I use oxygen and excercise I get a lot of mucous from the nasal passages - this is NOT an exacerbation.
WARNING -
If you or your partner/carer notice your lips going blue or indeed anywhere going blue and if you nave no oxygen ring 999 immediately. If you have oxygen use it but no more than 2 litres a minute unless otherwise instructed by your consultant or respiratory team. And if you have never experienced this before ring your GP immediately. One carer wrote in and said that this happened to her husband after walking only 50 metres. Urgent referral is then necessary for a possible prescription for ambulatory oxygen. COPD patients with many bronchial infections must monitor their condition very carefully with the help of their GP. And if you cough up blood go to your GP at once (see below).
Equally beg, borrow or buy a weighing machine and if you keep losing weight see your GP (more about that under diet & exercise).
IF YOU HAVE AT LEAST TWO OF THE FOLLOWING YOU PROBABLY HAVE AN EXACERBATION.
(a) An increase in phlegm from the lungs.
(b) Especially a colour change of that phlegm to yellow or green
(b) Increased breathlessness that does not respond to increased medicine but is related to (a) or (b)
What do I do if it is an exacerbation?
Well you see or telephone your GP at once.
Many patients with severe COPD have already been given antibiotics and perhaps steroids, oral prednisolone (not the inhaled kind!) to keep at home. If I have yellow or green phlegm or sore throat, I don't wait to be asked, I take them! Of course it might have cleared up without antibiotics but I don't take the chance. If you take antibiotics you MUST complete the course, otherwise germs will become resistant to the antibiotics. Always COMPLETE THE COURSE. IF IN ANY DOUBT RING YOUR GP IMMEDIATELY. If you are away from home and take your standby antibiotics and defeat the infection, make sure you tell your GP as soon as possible afterwards so that you can get them replaced .
Examples of antibiotics are amoxicillin, erythromycin and tetracycline. It might so happen that if you take one of these on a regular basis they may not work. If the infection does not start to clear up in the first few days, contact your GP at once and you may be given a different one.
I have been asked to point out that regular taking ORAL steroids, (not inhaled ones but in tablet form), is not normally recommended. For an infection or exacerbation taking these oral corticosteroids for a period of 7 to 14 days should normally be sufficient.
And just to remind you that if you cough up blood, red or brownish you must see your GP AT ONCE.
I did and was in hospital four hours later with pneumonia. That was back in 2000 when I hadn't been diagnosed with COPD and did not even have it diagnosed afterwards!
If you are in need of urgent advice and cannot reach your GP and are told he will ring you back as soon as possible, you can RING NHS DIRECT for an immediate response. 0845 4647 24 hours a day, 7 days a week.
They are brilliant. My wife rang them after I fell and they ordered an ambulance at once when she described the symptoms.
So is flu/influenza an exacerbation?
Well yes it is, but you shouldn't catch influenza. All COPD patients should receive a vaccination in the autumn at their GP practice, regardless of age. MAKE SURE YOU GET ONE AS SOON AS POSSIBLE - OCTOBER EVERY YEAR.
So what about pneumonia?
All moderate to severe COPD patients should have a pneumococcol vaccination that protects you against the most common types of pneumonia. If you haven't had one, ask your GP for one immediately. BE ON THE SAFE SIDE AND HAVE ANOTHER ONE AFTER 5 YEARS.
WHAT HAPPENS IF I'M ADMITTED TO HOSPITAL?
Well, most times, you will be given a course of antibiotics, steroids, use of nebuliser etc. to bring your infection under control. However, if your condition is serious, and you are a suitable candidate you might be given a NON-INVASIVE VENTILATION MACHINE to help you to breathe. I explain about it more under PROGNOSIS. I REPEAT THE PICTURE OF IT HERE. Honestly it is a breeze - nothing to fear - it just looks awful!!!!
How can I avoid exacerbations?
Well first you must read my TREATMENTS page. Taking your medication correctly and at the right times will help. Inhaled steroids, for example, have been proven to reduce the risk of exacerbations by improving the condition of the lungs. Then read my WEATHER page where you will read about precautions you can take in the winter and summer with regard to the heat, cold and pollen and pollutants.
Look at my WEATHER page and take heed.
Washing your hands on and off throughout the day is important. In particular wash your hands before you leave someone else's house, or after someone visits you or after you've left the house shopping or handled a supermarket trolley. Wash your hands after you use any toilet and use a tissue to open a public toilet door handle and discard it. Handles and handrails of any sort may carry germs - try not to touch them or wash your hands as soon as possible afterwards and meanwhile don't touch your face! Avoid shaking hands with your GP or anyone else for that matter. When I say wash I don't mean briefly passing your hands through water. Wash thoroughly with soap. And then with hand gel available from chemist. I always carry a bottle with me to wash after I've touched anything.
Always avoid people who have colds or hacking coughs or sneezes. If you are in a shop, hold your breath and back away quickly or if on a bus move your seat to sit as far away as possible or get off. If anybody (I also mean children) intends to visit you make sure they are well. It is not rude to tell them to stay away until they are better. It is your life that is being threatened. If you have a GP appointment present yourself a minute or two before the appointment. If the waiting area contains people with infections ask the person at the reception desk if you can sit outside until the GP can collect you. Giving up smoking and avoiding exacerbations are the best ways to prolong your life.
Keeping fit with exercise is essential so see the pulmonary rehabilitation page and the exercise page. Not only does exercise strengthen the immune system but it also builds up your muscles so you use less oxygen and therefore experience less breathlessness . Having a good diet and sleep is essential and there is about that on the DIET page.
If you are overweight you will become more breathless.
If you continue to smoke then you will be more liable to pick up infections, so STOP SMOKING and live longer.
Remember that each time you have a major exacerbation, which I define is one where you have to go to into hospital, your general lung functioning may get worse, even when you return home. So it is essential that you treat exacerbations or suspected exacerbations AT HOME to avoid them getting worse. If you are not sure if you have an exacerbation then
RING your GP or NHS Direct Help Line ( 08454647 - open 24 hours a day) or get someone else to do it for you".