Exacerbation of chronic obstructive pulmonary disease

Doctor Mai Manh Tam – Department of Respiratory Medicine, Tam Anh General Hospital, Hanoi, said that an exacerbation of COPD is a condition in which acute respiratory symptoms change from a stable stage, the disease worsens suddenly, negatively affects lung function, requires change. in the usual treatment regimen. In addition, there are many cases of patients whose exacerbations were not detected in time, delaying treatment, leading to a severe prognosis.

People with chronic obstructive pulmonary disease are at risk for exacerbations. Common warning signs for an outbreak are wheezing, worsening cough or shortness of breath, shallow or rapid breathing, increased heart rate or temperature, and a change in the color of the sputum.

People with COPD may experience one or two exacerbations per year, and these tend to get worse over time.

Risk factors and triggers that cause COPD exacerbations: smoking or frequent exposure to secondhand smoke, living and working in polluted and smoky environments, older adults (over 40 years), lung function More decline is also one of the factors risk.

COPD exacerbation symptoms

The lungs are responsible for exchanging Oxygen and Carbon Dioxide (CO2) to carry out the body’s life cycle, with COPD sufferers will have more difficulty in this metabolism because the lungs do not work properly. This can lead to a buildup of Carbon Dioxide and a decrease in oxygen levels. If CO2 builds up in the body in excess or oxygen levels become too low, it can lead to death.

A clear sign of an impending COPD exacerbation is difficulty breathing. The patient feels suffocated in the chest, the amount of air received is not enough. This occurs even when the person is active with light physical activity or even at rest.

Some other symptoms to look out for:

Shortness of breath: People with COPD are often unable to breathe comfortably, feel that there is not enough air to breathe, and shortness of breath tends to increase gradually. If this condition persists and gets worse, or the patient feels short of breath even at rest, they should take supportive medication and seek medical help immediately. It can be said that this is also one of the common symptoms of COPD exacerbations.

Stridor: For patients with chronic obstructive pulmonary disease, stridor is common during expiration. This sound is produced due to airway obstruction due to the accumulation of secretions, purulent sputum.

Wheezing: The wheezing phenomenon in people with COPD is also caused by the airways being partially blocked by mucus and pus.

Chest pain: During a COPD exacerbation, the patient will feel more forced to breathe, causing a feeling of tightness and heaviness in the chest. During an exacerbation, the patient’s breathing may become irregular, the chest moving up and down abnormally rapidly.

Cough: For patients with chronic obstructive pulmonary disease, coughing that is more frequent and more severe than usual can be a symptom of a COPD exacerbation. At this time, the patient may have a dry cough, or a cough with yellow and green phlegm.

Discoloration of the skin or nails: During a COPD exacerbation, a person may experience noticeable changes in skin color such as: bluish tinge around the lips, paleness of the face; and the nails will also be blue, purple. This is a sign of respiratory failure.

Difficulty sleeping and loss of appetite: As the symptoms of a COPD exacerbation increase, the patient may feel tired, refuse to eat, and experience insomnia.

Headaches in the morning: This is also considered a real sign of a COPD exacerbation. In people with chronic obstructive pulmonary disease, low blood oxygen (SpO2) levels and excess carbon dioxide build up in the blood are causes of early morning headaches.

Fever: This is also considered a sign of infection and the beginning of an impending COPD exacerbation.

Anxiety, excitement: During an acute episode of COPD, the patient will feel that he is not getting enough oxygen. This not only causes shortness of breath, but also brings feelings of anxiety and panic.

Inability to speak: A person with severe respiratory distress may not be able to speak properly. Instead, the patient must use gestures to convey what he wants to convey.

Causes of COPD exacerbations

The most common and direct cause of exacerbations, accounting for more than 80% of exacerbations, is infection (superinfectious COPD), which can be viral or bacterial.

Common viruses: Rhinovirus, Influenza, Parainfluenza, Respiratory Syncytial Virus (RSV), Human Metapneumomia Virus, Picornaviruses, Coronavirus (Covid 19), Adenovirus,…

Common bacteria: Haemophilus Influenzae, Moraxella Catarrhalis, Staphylococcus Aureus, Streptococcus Pneumoniae,… In addition, some other causes of exacerbations of chronic obstructive pulmonary disease may be associated with:

Medical factors: patients with pulmonary embolism, pneumothorax, respiratory muscle fatigue, drug withdrawal, incorrect drug regimen, patients taking sedatives, beta-blockers, anesthetics, arrhythmias and metabolic disorders, infections of other organs, ..

Surgical factors: Fracture, thoracic trauma, after abdominal and thoracic surgery, 1/3 cases with unknown cause.

COPD diagnosis

According to Anthonsen’s criteria, an exacerbation occurs in a patient with a diagnosis of COPD who suddenly develops one or more of the following symptoms: increased dyspnea, increased sputum, sputum discoloration, with or without other systemic symptoms (fever, chest pain). , loss of consciousness…)

In addition, doctors will rely on signs of aggravation of COPD exacerbations to diagnose and treat. Some clinical signs:

Breathing: dyspnea at rest, cyanosis, SPO2 less than 88%, contraction of accessory respiratory muscles, paradoxical chest and abdominal movements, respiratory rate above 25 breaths/minute.

Cardiovascular: heart beats more than 100 beats/minute, irregular heartbeat, cyanosis, edema of the lower extremities.

Irritability, impaired consciousness.

Blood gases: PaO2 less than 55mmHg, PaCO2 above 45mmHg.

The patient has a history of long-term oxygen therapy at home, co-morbidities: cardiovascular disease, alcoholism, nervous system damage…

COPD exacerbation rate

Anthony’s classification of the severity of COPD exacerbations

Mild COPD exacerbation: Having one of 3 severe symptoms, namely shortness of breath, amount of sputum, cloudy color, yellow and other accompanying symptoms such as cough, stridor, fever without cause. In the previous 5 days, there was a respiratory infection. Respiratory rate, heart rate increased by more than 20% compared to the original.

Moderate exacerbation of COPD: 2 of 3 severe symptoms: shortness of breath, amount of sputum, cloudy color, more yellow. Currently, the patient should use antibiotics if the color of the sputum is not good.

Severe exacerbation of COPD: has the following 3 severe symptoms: shortness of breath, amount of sputum, cloudy color, more yellow. The patient is advised to take antibiotics.

Classification of severity of COPD exacerbations according to the revised ATS/ERS

Mild COPD exacerbations: Feeling short of breath when walking fast, climbing stairs; normal breathing; there is no phenomenon of contraction of the respiratory muscles and sternum; 1 of 4 symptoms: new or worsening purulent sputum, fever, cyanosis and/or edema. Controlled by increasing the daily dose of the therapeutic agent.

Moderate COPD exacerbation: Shortness of breath when walking slowly indoors; respiratory rate 20-25 breaths/minute; there is often a phenomenon of contraction of the respiratory muscles and the sternum; 2 of the following 4 symptoms: new or worsening purulent sputum, fever, cyanosis and/or edema. Patients should be treated with systemic corticosteroids or antibiotics.

Severe and very severe COPD exacerbations: Shortness of breath even at rest; severe shortness of breath, yawning of breath; speak slowly or not speak at all; consciousness: drowsiness, confusion, coma; respiratory rate of 25-30 breaths/minute or slow, even stopping breathing; paradoxical thorax – abdominal movements; the appearance of contractions of the respiratory muscles and the sternum; 3 or all 4 of the following symptoms: new or worsening purulent sputum, fever, cyanosis and/or edema. Patients currently need to be hospitalized immediately or seek emergency care for timely intervention.

COPD exacerbation complications

In patients with frequent exacerbations, it will lead to an increase in respiratory disease, a decrease in quality of life, an increase in treatment costs, an increase in the rate of decline in respiratory function and disease progression. can cause death. Patients with more exacerbations had a higher mortality rate.

In addition, the survival rate of patients after exacerbations decreased over time, a multi-center integrated study of 25 centers around the world, the study showed that more than 1000 patients who had experienced COPD exacerbations, after 2 years, the patient’s survival rate decreased to 50 ,7%. In addition, the prognosis of respiratory function decreases, air trapping increases, especially in hospital infections, multiresistant bacteria increase.

In addition, patients after experiencing an exacerbation of COPD are also at risk for the following dangerous complications:

Pneumothorax: Long-term airway obstruction is the cause of the inability to expel air in the alveolus, resulting in a buildup that causes dilatation of the alveolus, resulting in emphysema. Then, these alveoli will gradually become larger and burst into the pleural cavity, causing a very dangerous complication of a pneumothorax.

Pulmonary hypertension: This complication occurs due to changes in the structure of the blood vessels in the lungs, which increases the pulmonary pressure.

Heart failure: This is considered to be one of the most dangerous COPD exacerbations that patients need to be aware of. Thus, this complication occurs due to increased pulmonary artery pressure, accompanied by prolonged hypoxia, leading to right heart failure. Over time, right heart failure combined with chronic hypoxia will lead to left heart failure, total heart failure.

In addition, COPD exacerbations also leave other dangerous complications such as lung cancer, osteoporosis, gastroesophageal reflux, neurological complications or malnutrition.

Le Nguyen

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