If you have chronic obstructive pulmonary disease (COPD), you're at an increased risk for developing other health problems, such as osteoporosis, gastroesophageal reflux disease (GERD) , diabetes, and heart disease. But there are certain times when COPD patients are more vulnerable to heart attack or strokes than other people: in the days and weeks after an exacerbation, a serious flare-up in symptoms, which can land you in the hospital.
Exacerbations are often a fact of life if you have severe COPD, according to Byron Thomashow, MD, clinical professor of medicine at Columbia University, medical director of the Jo-Ann F. LeBuhn Center for Chest Disease at NewYork-Presbyterian Hospital, and chairman of the board of the COPD Foundation. Whether it's air pollution, a cold, or another lung infection that sets them off, exacerbations can ramp up your shortness of breath or cough to dangerous levels.
"I think about three-quarters of patients have at least one a year," he says. "Even in those people who successfully get through an exacerbation … it can take months and months to get back to their prior level of quality of life and function even though the symptoms go away quickly."
In general, people with more exacerbations tend to have poor lung function, reduced activity, increased inflammation, and higher mortality rates.
What causes exacerbations
The flare-ups are typically caused by infections from a virus or bacteria (particularly for smokers, who are at an increased risk of getting infected). Medications to treat COPD, including inhaled steroids like Advair, can also increase the risk of pneumonia, which can result in exacerbations. The risks have to be weighed with the potential benefits, and not using medication correctly can itself result in exacerbations.
In about one-third of flare-ups, there is no obvious cause, says William Barkman, MD, MSPH, a pulmonologist and chief of staff at the University of Kansas Hospital, in Kansas City, Kan.
"It could be environmental, or sometimes people stop taking their medications, which can lead to an exacerbation. And occasionally a comorbid disease like heart failure is the cause," Dr. Barkman adds.
To reduce the risk of problems related to COPD exacerbations, patients are typically treated with oxygen, medication, including beta agonists and antibiotics, and sometimes steroids to reduce inflammation.