COPD Exacerbations

It is estimated that exacerbations of COPD account for 1 in 8 urgent presentations to hospital making it the second largest cause of emergency admissions.

It is therefore important that you are familiar with how your COPD normally affects you so that you can spot any worsening at an early stage and take appropriate action.

What is an exacerbation?

An exacerbation of COPD can be identified by a sudden worsening of your symptoms. These may include:-

• Increasing breathlessness or wheeze
• Worsening cough
• Increasing sputum volume
• A change in the colour or consistency of your sputum

How is an exacerbation treated?

Treatment for an exacerbation will depend upon the symptoms you are experiencing and the severity of these.

For mild increases in breathlessness using your reliever inhaler more frequently (without exceeding the maximum prescribed dose) may be all that is needed.

If you breathlessness has increased significantly and is interfering with daily activities then a short course of oral steroids (prednisolone) may be prescribed.

Antibiotics may also be used if there has been a change in the amount of sputum you are producing or alteration in its colour.

What to expect and do after starting treatment

Hopefully you will start to feel better after 24-48 hours of starting treatment. It is important that if you feel you are getting worse that you seek medical advice.
Other reasons to seek medical advice include:-

• Pain, tightness or heaviness in your chest
• Pain in your arm, neck back or jaw
• Being so out of breath that you cannot speak normally
• You or carer notice that you appear blue or have become confused or drowsy

In these situations you should call 999.

After completing the treatment you may still feel fatigued which may last for a few weeks but you will hopefully notice your breathing has improved and your sputum has returned to its normal appearance. If you are still having problems get in touch with your GP.

Try to keep a record of the number of exacerbation you have each year. If you are having more than two courses of antibiotics or steroids a year then see your GP as changes to your inhalers may be required as well as further investigations. These may include checking your sputum for unusual bacteria as well as detailed scans of your chest.

Your GP may also provide you with a rescue pack consisting of steroid tablets and antibiotics to use should you develop symptoms of an exacerbation. It is important to ensure you know when to take either or both of these medications and ensure you seek help if you are not getting better. Always let your GP know if you have had to start using your rescue medication.

Useful resources
1. COPD Patient.Info leaflet
2. British Lung Foundation info