What Are the Causes of COPD Exacerbation?
Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that worsens with age, but it can be slowed by avoiding episodes of acute exacerbation. Infections and pollution contribute to most exacerbations, but the cause is unknown about 30 percent of the time. Despite the significant financial and social burden of COPD exacerbations, scientists with the National Heart, Lung and Blood Institute (NHLBI) claim to know relatively little about the causes of exacerbation.
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Discussion
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Exacerbation is a sudden worsening that requires a change in treatment for symptoms that exist with COPD: cough, shortness of breath (dyspnea) and sputum production. Exacerbations are diagnosed subjectively because the severity of a patient's symptoms can only be compared to his usual condition. For example, one patient with very severe COPD may be stable, while another with moderate COPD and similar test results could be experiencing an exacerbation. There is no specific definition of exacerbation or test to diagnose it.
However, the NHLBI considers an exacerbation to be an emergency situation when a COPD patient develops:
• unusual difficulty walking, talking or completing a sentence
• labored, fast or heavy breathing
• rapid or irregular heart rate
• cyanosis--blueness of the lips or fingertips
Infection
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Between 50 and 75 percent of exacerbations are caused by upper respiratory infection or pneumonia. The COPD patient is particularly susceptible to respiratory infections because he is unable to effectively clear mucus and other secretions from his airways, which creates an environment in which bacteria and viruses thrive. The common cold and other viruses are the greatest offenders. Bacterial infections contribute to exacerbations to a lesser degree and occur more frequently among patients who have used antibiotics extensively in the past.
Swallowing problems (dysphagia) may contribute to exacerbation of COPD by increasing the risk of aspiration pneumonia, which occurs when food or liquid is accidentally inhaled. Up to 20 percent of COPD patients have dysphagia.
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Air Pollution
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Indoor and outdoor air pollution is known to cause at least 10 percent of all COPD exacerbations. The Centers for Disease Control and Prevention (CDC) states that avoidance of smoking and exposure to second-hand smoke, traffic congestion, industrial pollutants, and occupational dust and chemicals is the most important aspect in the successful treatment and prevention of exacerbations.
Unknown
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About one third of exacerbations are from unknown or unspecified causes, although certain correlations exist. Physical inactivity has been identified as one of the most significant trends in repeat hospital admissions for exacerbation of COPD. Previous exacerbations increase the risk for future and recurrent exacerbations. A failure or inability to take medications as prescribed may account for exacerbations in an otherwise stable patient. Patients with an extensive history of antibiotic or corticosteroid inhaler use are also at greater risk for exacerbation of COPD.
Exacerbations have also been linked to worsening of other health conditions commonly seen with COPD, such as congestive heart failure, respiratory failure, sleep disorders, blood clots, gastroesophageal reflux disease and depression.
Prevention
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While the specific causes of COPD exacerbation remain unclear at times, the preventive measures are well documented. It is recommended that COPD patients stop smoking, exercise regularly, get enough sleep, eat properly and wash hands frequently, especially during cold and flu season to reduce the risk of infection and exacerbation. The NHLBI also recommends taking medications as directed, participating in a pulmonary rehabilitation program, avoiding pollution and taking the flu and pneumonia shots.
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References
- American Journal of Respiratory and Critical Care Medicine; NHLBI workshop summary; Croxton, TL, Weinmann GG, Senior RM and Hoidal JR; March 15, 2002.
- NIH Publication No. 07-5841; Breathing better with a COPD diagnosis; National Heart, Lung and Blood Institute; December 2006
- Department of Human Services Fact Sheet; Facts about chronic obstructive pulmonary disease; Centers for Disease Control and Prevention; August 2003
