A COPD exacerbation is typically defined as a shortness of breath episode significant enough that a patient seeks physician intervention and can often lead to an emergency room visit or hospitalization. Exacerbations commonly occur in COPD patients as a result of significant airway inflammation most often caused by some combination of prolonged exposure to cigarette smoke, upper respiratory infections and/or dramatic increases in the production of sputum.
Many recent pulmonology research efforts have explored ways to treat exacerbations, reduce the number and severity of future exacerbations and to find ways to identify patients who are likely to be most susceptible to exacerbations (with an eye towards heading off the problem before it occurs).
The most common solutions prescribed by physicians to address exacerbation symptoms are in the form of antibiotics, corticosteroids, and bronchodilator medications. The antibiotics help suppress respiratory infections and clear sputum. The corticosteroids and bronchodilators typically help suppress airway inflammation. Sounds like an easy set of solutions, right? Well, it is true that these medications do help reduce exacerbation symptoms but unfortunately most are effective in relieving immediate symptoms and do not produce lasting benefit or protection against future exacerbations.
For those thinking proactively (i.e. trying to avoid future exacerbations) the treatment option that offers the best, longer-term protection is smoking cessation. Prolonged exposure to cigarette smoke damages the integrity of lung tissues over time as the pro-oxidant free radical molecules present in cigarette smoke in massive quantities nick away at the protective lining of the airways, exposing underlying cells to the toxic chemicals in cigarette smoke. Those toxic chemicals eventually disrupt the normal lung cell function and stimulate inflammation.
Beyond smoking cessation, another effective method for reducing exacerbations is a COPD treatment known as pulmonary rehabilitation. Pulmonary rehab is an exercise centered treatment program designed to build patient physical endurance and strength. Research studies have shown that an 8-12 week pulmonary rehab program is effective in reducing COPD patient shortness of breath, reducing the frequency and severity of exacerbations, reducing future hospitalizations, improving physical conditioning, and improving patient quality of life.
There is also growing research evidence that many COPD patients are deficient in vital nutrients known as antioxidants. In studies where certain antioxidants are supplemented (through food or dietary supplements) in human COPD patients and smokers, human lung tissue samples exposed to cigarette smoke, and laboratory animals exposed to cigarette smoke, there have been many published results showing a significant reduction in lung tissue inflammation. So there appears to be growing sentiment for supplementing antioxidants as a proactive ongoing measure against lung inflammation (and by extension future exacerbations).
But what about methods to predict or identify those most susceptible to COPD exacerbations? Well, a new research article examined several potential “leading indicators” and concluded that among the leading indicators self-reported quality of life ratings seem to be a strong potential predictor of those most likely to have frequent future exacerbations.
The study, published online ahead of print in The Clinical Respiratory Journal, followed 121 COPD patients in a year-long study. The Sweden based research team selected several potential “leading indicators” to measure at the outset of the study including previous 3-month corticosteroid use (signaling a recent previous exacerbation episode), self-reported quality of life survey ratings, inflammation-related markers in sputum samples, body-mass-index scores, and a set of diagnostic test measures of physical condition (6 minute walk test) and lung function (spirometry).
During the course of the 1 year study, the COPD patients and their physicians reported subsequent exacerbations to the study team. At the end of the study period, the researchers divided the 121 COPD patients into two groups. In one group, study subjects who had 2 or more exacerbations during the study were denoted as “frequent exacerbators”. The other group, those who experienced less than 2 exacerbations during the study period were classified as “infrequent exacerbators”.
Then the researchers examined the differences in the “leading indicators” measured at the outset of the study to determine which, if any, indicators were substantially different between the two groups. The only two indicators that delivered statistically significant differences were “past 3-month corticosteroid use” and low self-reported quality of life survey ratings. (Brusse-Kaizer MGJ, et al. Clinical predictors of exacerbation frequency in chronic obstructive pulmonary disease. The Clinical Respiratory Journal. Accepted Article; doi: 10.1111/j.1752-699X.2010.00234.x)
The past 3-month corticosteroid use makes intuitive sense. The steroids were most likely prescribed for a previous exacerbation event and therefore indicative of someone susceptible to future exacerbations.
The quality of life survey ratings were more intriguing as a potential predictor in our opinion (especially in alerting COPD patients of potential quality of life warning signs to keep an eye on). Two particular questions on the Health Quality of Life survey used in the study showed strong correlation as predictive of future exacerbations. As the researchers explained, “The factors “being in control of health”, “panic”, and “disturbance of daily life” could be worse in less stable patients and these patients could therefore be identified as being at higher risk of being frequent exacerbators, something that to our knowledge has not been analyzed in this way before. Indeed, the question “I feel that I am not in control of my chest problem” was answered positively more often by frequent (35.5%) than by infrequent exacerbators (12.2%). Similarly, the question “I get afraid or panic when I cannot get my breath” was answered positively more often by frequent (38.7%) than by infrequent exacerbators (22.2%)”.
In other words, COPD patients who are increasingly concerned that they are not in control of their chest problem and/or sense a increasing degree of panic when they can’t catch their breath are among those most likely to experience a COPD exacerbation within the year.
In our opinion, if you find yourself feeling this way about either issue and you want to take proactive steps to avoid a COPD exacerbation, you would be well served to discuss your concerns with your physician and to explore smoking cessation, pulmonary rehabilitation, and antioxidant supplementation.
Smoking cessation and antioxidant supplementation will help reduce inflammation. Pulmonary rehabilitation will help boost your physical condition, reduce shortness of breath, and promote a greater sense of control of your breathing. The combination of these three treatment options combined with medications prescribed by your doctor can significantly reduce the likelihood of future exacerbations and the severity of an exacerbation if one does occur.
To learn more about inflammation and what steps you can take to reduce it, we recommend reading our article, War of the Worlds in Your Lungs, and considering following our 5 Step Feel Better NOW Plan.
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