Recognising a COPD ‘flare up’ can be life-saving: Here’s how to do it

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There are several steps you can take to help ward off a COPD flare up this winter.

Feeling breathless. Struggling to complete daily tasks or even take a gentle walk. Coughing fits. While confronting, all these things can become a part of daily life for someone living with Chronic Obstructive Pulmonary Disease (COPD).

The disease, which impacts one in seven Aussie adults aged over 40, affects the breathing tubes or airways of the lungs. When the airways are damaged, people experience uncomfortable breathlessness, persistent coughing and increased mucus production that sees them coughing up sticky phlegm.

COPD is irreversible, although there are good pharmaceutical and other treatments doctors can prescribe to slow down the progression of the condition.

But untreated COPD will almost always worsen, because people with the disease suffer what’s called exacerbations, or ‘flare-ups’ of their COPD. And those flare-ups are what lead to hospitalisation and, even more worrying, an increased risk of heart attack or stroke in the months following.

That makes recognising the symptoms of COPD and being diagnosed and treated vital.

“Depending on the severity of the flare up, the risk of not managing the flare-up is potentially fatal,” warns Lung Foundation Dr Kerry Hancock, chair of Lung Foundation Australia’s general practitioner advisory committee. “For those people who have milder disease, then there’s a risk of causing further damage to their lungs with each flare up. That damage isn’t reversible.”

For Kaye Powell, it took being admitted to hospital with pneumonia before she was diagnosed with COPD, and since her diagnosis she’s had multiple flare ups of her condition.

“I’ve just come out of hospital, actually,” the grandmother from the Australian Capital Territory told Starts at 60 of her most recent flare-up. “It’s extremely difficult because it’s very hard to breathe. It affects your whole life.”

In extreme cases of COPD, people can feel like they can barely breathe because lung function can shrink to as little as 15 per cent of what is normal.

Catching a virus, such as the flu or even the common cold puts people with COPD at risk of a flare up, which makes winter a more dangerous time for those whose condition isn’t being managed.

Dr Hancock advises people with COPD to stay away from loved ones with colds, even if that happens to be their grandchildren. During winter months where there are lots of people with symptoms of cold and flu, it’s important to also maintain good hand hygiene.

“A snotty nose can mean they’re excreting rhinovirus, which might not have too much of a consequence for a toddler or preschool child, but can have significant consequences for the grandparent who has COPD,” she explains.

For Kaye, winter limits the activities she can participate in.

“If the air is too cold outside, it’s terribly hard for me to breathe,” she says. “If I open the front door and it’s not a very nice day, I tend to have to stay inside.

“You’re supposed to stay active, do exercises but sometimes that’s difficult. I tend to go to the [shopping centre] and do my walking around there so at least I’m warm.”

Getting vaccinated against influenza and pneumonia is another important step for people known to have COPD, Dr Hancock says, while other important protections include remaining active and taking all medications as prescribed.

Symptoms of a flare up can increase worsening breathlessness, an increase in phlegm or the phlegm becoming thicker. These symptoms can easily be confused with those caused by other common conditions, so Lung Foundation Australia created the ‘Have the CHAT’ campaign to help people identify the signs of a flare-up and seek early treatment.

CHAT is acronym. The C in CHAT stands for coughing more than usual, H stands for harder to breathe, A is any changes in sputum or phlegm, while T refers feeling increasingly tired. Answering yes to any of these questions means people with COPD should schedule an appointment with their doctor ASAP.

Kaye has already pre-booked appointments with her doctor for every week in June, July and August, or what she calls her “worst months of the year”. That way, her doctor can manage not only her COPD, but other chronic conditions that can be impacted by a flare-up.

“I have antibiotics and steroid tablets to be able to take if I get worse before I can get to her,” Kaye says of her doctor. “It’s like a prevention. If I start coughing a lot, I can start taking the medication myself so it doesn’t get any worse.”

Over the longer term, pulmonary rehabilitation – usually in the form of a supervised exercise and education program – can be a good treatment for COPD, because the condition tends to make some people cut back on their physical exercise for fear of breathlessness, when in fact some physical exertion is needed to help keep COPD in check.

“We have very good evidence that patients who participate in pulmonary rehabilitation have less risk of having a flare-up of their COPD and less risk of being hospitalised because of their COPD,” Dr Hancock notes.

These sessions with a specially trained pulmonary exercise instructor are usually spaced out over eight weeks, although patients are encouraged to continue exercises afterwards to decrease flare-ups and other COPD symptoms.

In addition to advice and care from her GP, Kaye says she gets valuable support from one of the many COPD support groups across Australia that help people live with the condition.

“The best thing I found was I’m part of a COPD self-help group,” she says. “We meet every month and we all talk about how we’re feeling, everybody coughs, everybody wheezes. It’s a relaxing place, you don’t have to explain yourself. We have different speakers and it’s extremely helpful to be able to talk to like-minded people with the same disease.”

Dr Hancock adds it’s important to do everything possible to prevent flare-ups because each one further damages the lungs.

“It’s a bit of two steps backwards, one step forward,” she says. “After a severe flare-up where people have had to be hospitalised, there’s an increased risk of stroke or heart attack in the months afterwards, so it’s critical to be proactive and take every step you can to reduce your risk of a flare-up.

Do you have COPD? What symptoms caused you to seek a diagnosis?

Stay well and out of hospital this winter. If you have experienced an increase in coughing, shortness of breath, low energy or a change in phlegm, it’s important to Have the CHAT with your doctor.