Acute Exacerbations of Chronic Bronchitis
Chronic bronchitis and emphysema are together called chronic obstructive pulmonary disease, or COPD. This is a chronic condition, usually attributed to tobacco smoking, causing shortness of breath and cough, leading to limitation of everyday activities like walking.
When breathing becomes more difficult for a person with COPD, they may be experiencing an acute exacerbation of COPD (AECOPD). During an acute exacerbation, breathing becomes more difficult because of further narrowing of the airways and secretion of large amounts of mucus that is often thicker than usual.
Acute exacerbations of COPD occur more frequently as a person's COPD worsens. The further narrowing of airways in people with COPD that results in a flare-up or acute exacerbation can be caused by allergens (e.g., pollens, wood or cigarette smoke, pollution), toxins (a variety of different chemicals), or acute viral or bacterial infections.
Bacterial infections are usually associated with mucus that turns a yellow or greenish colour and is typically much thicker than usual. Coloured mucus does not necessarily mean the person has a bacterial infection, however.
When a person has severe chronic lung disease from smoking, it may take something as minor as a chest cold to make their breathing so severe that they must be hospitalized.
Symptoms and Complications
AECOPD is associated with increased frequency and severity of coughing, accompanied by worsened chest congestion and discomfort. Increasing shortness of breath is also typical, and wheezing may be present as well.
People suffering from an acute exacerbation caused by infection may feel weak and have fever and chills. Doctors may recommend a chest X-ray to ensure that pneumonia is not the cause for these symptoms. Blood in the sputum may also indicate other medical conditions and should be reported to your physician promptly.
Making the Diagnosis
An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is said to have occurred if there has been an increase in frequency and severity of cough, along with larger amounts of sputum, or increasing shortness of breath beyond usual daily symptoms.
The challenge lies in diagnosing the cause of an AECOPD so that the best treatment can be put in place. Therefore, it is important for the person with AECOPD to give their doctor a detailed description of the circumstances that may have led to the particular episode. For example, was there exposure to inhaled irritants such as secondhand smoke in the recent past? It is also important to describe any symptoms experienced to the doctor (e.g., fever, chills).
Your physician may investigate your AECOPD with a chest X-ray, a blood oxygen level test, or other blood tests. Treatment is often started before the test results confirm the condition.
Treatment and Prevention
Prevention of acute exacerbations for a person with COPD includes:
- quitting smoking and avoiding dust, second-hand smoke, and other inhaled irritants
- immunization against influenza (yearly) and pneumonia (single injection, or several as recommended by your doctor)
- regular exercise, appropriate rest, and healthy nutrition as discussed with health professionals
- avoiding people who currently have an infectious respiratory disease such as a cold or influenza
- maintaining good fluid intake and humidifying the home to help reduce the problem of thick sputum and chest congestion
Treatment of AECOPD may include:
- inhaled bronchodilators: Treatment with bronchodilators such as salbutamol and ipratropium* open up the airways in the lungs.
- Antibiotics: This treatment is used if a bacterial infection is the suspected cause. Antibiotics will not help infections caused by viruses. Viral infections will usually go away on their own with the aid of proper rest and care. However, other medications may be needed to control symptoms.
- corticosteroids: Oral prednisone reduces inflammation in the airways. It is usually used for a short period of time when an acute exacerbation occurs..
- oxygen therapy: A physician will recommend this if your blood oxygen level is too low. Some people with severe COPD require oxygen on an ongoing basis. Portable "home oxygen therapy" allows a person to remain mobile while receiving this therapy.
Any person with chronic bronchitis should have a treatment or "care plan" in place for those times when an acute exacerbation suddenly hits. A doctor and patient must agree on which symptoms to watch for (e.g., shortness of breath, change in character or amount of mucus) before the person starts self-treatment. Such plans allow a person to start treatment right away so symptoms are kept as much under control as possible until a doctor can be seen.