Topic Overview
When you have
COPD, especially if you have chronic
bronchitis, you may sometimes have sudden attacks
where your breathing and coughing symptoms suddenly get worse and stay that
way. These attacks are called COPD exacerbations, or flare-ups.
With treatment, many people recover and return to the same level of shortness
of breath they had before the attack.
These attacks are often
life-threatening. If your symptoms suddenly get worse, and if taking your
medicine doesn't help, have someone take you to the emergency room. Call
911 if needed.
COPD attacks
often occur more frequently, last longer, and are more severe the longer you
have COPD.
Cause
The two most
common causes of a COPD attack are:1
- A lung infection, such as
acute bronchitis or
pneumonia. Infections are the most common cause of
COPD attacks. Infections usually are caused by viruses but can also be caused
by bacteria.
- Air pollution.
Other causes may include
heart failure,
allergic reactions, inhaling food or stomach contents
into the lungs, and exposure to temperature changes or chemicals. In about 33
out of 100 attacks—about a third—the cause is not known.1
Here's what happens during an attack:
- Your lungs may suddenly produce more
mucus. Or the airways of your lungs (bronchial tubes)
may suddenly get narrower.
- These two things reduce the airflow in
your lungs.
- And that makes it harder to breathe and makes your
coughing worse.
Symptoms
In a COPD
attack, your usual symptoms suddenly get worse:
- You have more shortness of breath and
wheezing.
- You have more coughing, with or without
mucus.
- You may cough up more mucus than
usual, and it may be a different color.
Some people also have a fever, insomnia, fatigue, depression,
or confusion.
Treatment
Treatment of a COPD attack depends on how bad it is. It may involve several
visits to your doctor's office or clinic. Or you may need to be treated in the
hospital.
To treat COPD attacks, experts recommend:
- Bronchodilators,
which are medicines that relax the bronchial tubes and make it easier to
breathe. These medicines may include:
- Inhaled anticholinergics (such as ipratropium).
- Beta2-agonists (such as albuterol).
- Oral corticosteroids, which
are medicines that reduce the swelling in your airways and may make breathing
easier. They are typically given for 5 days to up to 14 days to those who
aren't already taking them as part of their long-term treatment.
- A machine to help you breathe. This is
called mechanical ventilation. It is used only if medicine is not helping and
you are having a very hard time breathing.
- Oxygen, to increase the amount of oxygen in your
blood.
- Antibiotics, which are often used
when a bacterial infection is considered likely. People with COPD have an
increased risk of
pneumonia and frequent lung infections. Although most
infections are caused by viruses, some are caused by bacteria. Most studies
support the use of antibiotics. But some experts believe that since most
breathing attacks are caused by viruses, antibiotics should not be used unless
there is a known bacterial infection.
Treatment may also include:
- Intravenous (IV) fluids, to treat
dehydration.
- Other bronchodilators, such as
intravenous theophylline. These are used only if other
treatments don't work.
- Diuretics, which remove water from the body by making
your body produce more urine. These medicines are used if you are suspected of
having heart failure.
