Bronchitic Exacerbations are acute, or frequently subtle sub-acute deteriorations in your COPD health, usually caused by an initial minimal bronchial infection. These initial mild infections may progress over several days into serious complications. Without question, your overall health, and in fact the length of your life, is substantially dependent on the frequency and severity of Bronchitic Exacerbations. It is therefore crucial that you understand this problem, and be able to recognize it early, and to know how to deal with it.
A Bronchitic Exacerbation is broadly defined as any sudden deterioration in your COPD status due to a bronchial infection. However, there are multiple conditions that may mimic a true bronchitic exacerbation, and generally they are:
1.) Bronchial Infection, either bacterial or viral. This is the usual precipitating reason for an exacerbation.
2.) Heart Failure, with secondary accumulation of fluid in the lungs, resulting from worsening of respiratory heart strain called Cor Pulmonale, or following a "silent" heart attack.
3.) Asthma exacerbation.
4.) Pulmonary Embolus, a blood clot in the lungs.
5.) Pneumothorax, or air in the chest cavity, a usually painful, but sometimes a "silent" or painless process.
6.) And other rarer causes.
A fundamental rule in medicine states it is better to prevent a problem than it is to treat the problem, or, if you have a problem, the earlier you start the treatment of that problem the better will be the outcome.
This module will give you some general health tips, and some specific things you should do to prevent Bronchitic Exacerbations. You will also learn how to recognize this problem early in the course of development, and with prompt treatment to minimize COPD exacerbations. And you must always remember, this is possible only with your active and ongoing participation in your health program.
First and foremost, carefully and consistently follow the program provided by your doctor and other health care providers. This may seem like trivial advice, but it is surprising how many patients fail to follow their programs or take their medicines properly.
If you are still smoking, you must stop all forms of smoking, totally and permanently. The importance of preventing further lung damage, and further impairing lung defense mechanisms, cannot be overstated.
Maintain a balanced and nutritious diet. If you are uncertain what this means ask your doctor for an explanatory handout. Keep a record of your weight, at least once a week. The increased "Work of Breathing" in COPD requires extra food calories, and unfortunately loss of appetite in COPD is common. If you are unable to maintain your weight you may need an additional liquid food supplement. A Dietitian can advise you about commercial dietary supplements, and may be able to provide you with a recipe for making you own liquid supplement very economically.
Vitamin supplements are generally not needed, but if you are marginal as to food intake they may be necessary. Ask your doctor for an economical generic multivitamins, and possibly with some of the more expensive supplements. Vitamin E is somewhat controversial, but as an "anti-oxidant" counteracting the "free radicals" of oxygen metabolism it finds many who recommend it, for a broad range of reasons. Generally about 400-500 mg twice a day is sufficient.
Maintain a good fluid intake, generally clear fluids, to the point where your urine is slightly paler than usual. This may help to keep the mucus in your lungs moister and softer and therefore easier to expectorate.
Stay active, and exercise as best you can, even if you become moderately short of breath. Make a point of going to the bathroom, and the kitchen or dining room for your meals, and the family room for general activities. As you learned in the exercise module, general deconditioning with weakness and debility is a common and serious problem in COPD. The more deconditioned you are, the more inefficient your muscles are, and the harder you must breathe to make up for this muscular inefficiency. Particularly important are the large anterior thigh muscles, the quadriceps muscles, that are crucial for getting out of a chair and walking. Ask you doctor to show you how to do "quadriceps exercises" and "isometric quadriceps exercises" that may be done even if you are temporarily confined to a chair or bed. Keeping these muscles "toned-up" is important for rehabilitation to an active walking condition. A Physical Therapy consultation may indicate a need for a more structured exercise program, or a so-called "Aquatic Exercise Program" in a swimming pool, or a Yoga Program.
Avoid dust and materials you find irritating to your nose and mouth, or that make you cough. A simple face mask may help. Be sure the filters in your home heating and air conditioning are changed at least monthly. Room air filters, and humidifiers seem to benefit some sensitive patients, particularly during the allergy seasons.
Be sure to get your "Influenza Shot" every year, and the separate "Pneumonia Shot" for bacterial Pneumococcal pneumonia prevention.
Regular bronchial medication sprays have been found to be beneficial in keeping your airways open, and in preventing Bronchitic Exacerbations. These are:
1.) Long acting "beta" bronchodilators, generally used regularly once or twice daily.
2.) Tiotropium, a new drug that acts on a different part of the airways, used once daily.
3.) And sometimes a corticosteroid inhaler, also acting in a different manner, used regularly as directed.
Your short acting "beta" broncodilator such as Albuterol is generally used as a "Rescue medication". It should be used for acute shortness of breath situations, and generally only if you cannot promptly normalize your breathing on your own with breathing control techniques or Pursed Lip Breathing. Excessive use of these rescue medications can lead to heart palpitations and insomnia, and the medication may develop diminished effectiveness if used too much. If you find that you need more and more of your rescue medication, and particularly if this happens over two or three days, you should notify your doctor, as this may be due to a Bronchitic Exacerbation or some other underlying problem.
Avoid people with Influenza or Colds, or if there is any suspicion they are in the process of developing same. They must have no contact with you. If these people are required to assist you, or prepare your meals, they must wash their hands and wear rubber or plastic gloves while handling the things you will touch. And they should use a face mask, and they must scrupulously avoid sneezing and coughing.
You should wear a face mask if these helpers are in the room, and you should also wash your hands before eating. Avoid visiting other parts of your home where visitors may have inadvertently contaminated the area during Flu outbreaks. And if visiting outside your regular room during vulnerable times, pay particular attention to mask and hand washing precautions. And always use tissues for coughing and sneezing, never handkerchiefs, as handkerchiefs become easily contaminated and further spread germs.
If you find that your ankles are swelling, or if you now have to sleep sitting up for breathing comfort, this may indicate abnormal fluid retention. Be sure to promptly notify your doctor and have this situation evaluated.
You must regularly monitor not only your general health, but particularly your sputum characteristics, for early signs of a Bronchitic Exacerbation.
You need to recognize a Bronchitic Exacerbation before the typical signs of a chest cold develop. These traditional signs are generally those of increased cough which produces dirty yellow or greenish-yellow phlegm, and fever, and feeling unwell or short of breath, and other signs of infection. This module will teach you how to recognize a Bronchitic Exacerbation in the beginning stages, before it causes serious deterioration of your lung function. And with early detection you have an excellent chance of effectively treating this problem at home and avoiding a hospital admission.
To do this you need to be familiar with the concept of the "silent area" of the lungs, the smaller airways deep in the lung that don't have cough sensors. An infection may quietly fester and progress in these small airways for several days before dirty phlegm progresses to the point where it reaches the cough receptors in the larger airways. It is these receptors that make you cough, and therefore spit up the dirty yellow or yellow-greenish phlegm that indicates a bronchial infection.
It is up to you to recognize changes in your sputum, before the early silent infection later progresses to the larger airways and is now recognized. And because sputum quickly dries out and otherwise changes with time, you cannot wait for someone else to examine it.
Almost all patients with COPD have increased sputum, which frequently is thicker and sometimes colored yellowish or brownish, especially in the morning. This is mucous that has been accumulating during sleep. Because sputum, and particularly dirty sputum, is distasteful, many patients cough it into the toilet or sink, or into a tissue, without looking at it.
This is a mistake. You need to examine your sputum regularly, and particularly the early morning sputum, to become familiar with your "normal" sputum characteristics, so you can detect small hints of potential trouble. You should also examine your sputum at least one other time during the day, preferably late afternoon.
With a Bronchitic Exacerbation your phlegm typically becomes thicker and stickier, and harder to expectorate. Do not be fooled into thinking that a decrease in the amount of phlegm you expectorate means that all is well. This is often an early warning signal. The infectious process may in fact be hidden in the smaller airways, and festering and progressively plugging-up your airways and robbing you of precious functional lung.
Should you manage to raise some phlegm early in a Bronchitic Exacerbation, typically it is slightly thicker, and stickier, and has a subtle opaque coloration. And within this opaque discoloration, if you closely examine this phlegm you may note some faint streaks of slightly yellowish coloration.
If you suspect by an absence of sputum, or the presence of sticky opaque sputum, that you are developing a Bronchitic Exacerbation, then it is very important that you watch for additional Common Cold or Influenza ("Flu") symptoms that must be promptly reported to your doctor. Typically these are a stuffy nose with watery discharge, and a sore "scratchy" throat. You may even feel the scratchiness progressing downwards, now accompanied by a hoarse voice, vague central chest discomfort, and a non-productive cough. Even if these viral "Flu" illness do not produce a Bronchitic Exacerbation, they usually temporarily damage the protective lining of the bronchi, making you more susceptible to a bacterial infection a week or two after recovering from this initial event. Be aware of this possibility of a secondary recurrence of bronchial infection coming on after your original Bronchitic Exacerbation situation has resolved.
1.) Signs of the Common Cold, or Influenza, or a "Flu-like" illness.
2.) Signs these viral or bacterial illnesses are progressing down into your lungs.
3.) A vague sense of being "unwell" (so-called prodromal symptoms).
4.) A vague sense of increased shortness of breath, usually first noted with effort, because your bronchial tubes are plugging-up and decreasing the amount of functional lung.
5.) A vague sense of general chest tightness, or heaviness.
6.) Increased time to recover from effort, or for those on oxygen, a feeling that more oxygen is needed. If you have an Oximeter (a device for measuring the oxygen level in your blood) you may find that you need more oxygen to maintain your optimal blood Oxygen Saturation.
7.) A decrease in your sputum volume.
8.) Thicker, and stickier sputum, possibly with a slight clear opaque tint to otherwise normal appearing phlegm, and sometimes with faint yellowish streaks.
9.) Signs of more obvious infection, with further malaise and mild fever, occasionally some chills, and often with an increased pulse rate.
10.) Progressive shortness of breath with effort.
11.) Increased breathing distress at rest.
12.) Increasing cough, now productive of thicker phlegm, which is usually yellow or yellow-green streaked, or with areas of dirty mucus.
It's important to initiate corrective measures before these last four late stages. With practice, you can detect early signs at least two or three days earlier, and begin home therapy that may prevent serious complications and avoid a hospital admission.
If you have reached the stage of coughing up thick dirty phlegm, and particularly if you have progressive increased shortness of breath, you need immediate medical attention.
Call your doctor for an urgent medical appointment. If your doctor is not available or the receptionist tries to delay the visit to a later date, go immediately to the Emergency Room of the hospital where your doctor has admitting privileges. There you will be evaluated for a potential serious complication such as pneumonia, or other potential problems. And if your breathing is significantly failing you may need immediate hospital admission and perhaps even use of ventilator support for respiratory failure.
Get this emergency medical evaluation, and do it now. Your life may depend on it.
Bronchitic Exacerbations can be quite devastating to your overall health. Even with a mild exacerbation which was promptly treated, you will not feel your old self for at least two weeks. For more severe exacerbations it may take several months, or for severe exacerbations requiring hospitalization even a year or more to fully recover.
Frequent episodes of Bronchitic Exacerbation, particularly if they are severe exacerbations, are often associated with premature death.
It is obviously in your best interests to recognize Bronchitic Exacerbations early, and to treat them promptly and effectively.