An acute exacerbation is more commonly known as a 'flare-up'. An acute exacerbation of chronic obstructive pulmonary disease (COPD) is a sudden worsening of COPD symptoms compared with the usual severity of symptoms. This often means a worsening of breathlessness and an increase in coughing, with more phlegm (sputum).
What is chronic obstructive pulmonary disease?
COPD is a lung disease with symptoms such as cough, sputum production and breathlessness. It cannot be cured but treatments can make the symptoms better. It is caused by obstruction in the airflow which usually worsens over months to years. A GP practice in the UK with about 7,000 registered people will have around 200 people with COPD on its list - and many of them will be undiagnosed.
COPD is now the preferred term for what used to be called chronic bronchitis, emphysema, or chronic obstructive airways disease.
What causes the flare-up?
Acute flare-ups (exacerbations) of COPD occur more often if your COPD isn't well controlled and you have more severe ongoing symptoms.
- Most exacerbations are caused by upper respiratory tract infections or chest infections caused by either viruses or bacteria.
- Really bad air pollution can also cause exacerbations, especially in the middle of big, busy cities.
Are there any tests?
You should see your doctor to check the diagnosis and make sure you're taking the right treatments. Often no investigations are needed if it's clear that an infection is making your chest worse.
Investigations may be needed if there is any doubt about why your symptoms have become worse. These tests may include:
- Blood tests (including tests to check for anaemia and kidney function).
- A heart tracing (electrocardiogram - or ECG).
- Samples of your sputum sent to the hospital laboratory to check for an infection.
- A chest X-ray.
You may need admission to hospital for further investigations if your symptoms are severe or the diagnosis isn't clear.
Lung function tests (spirometry) are not useful during an exacerbation and so are not usually recommended.
What is the outlook?
Most flare-ups (exacerbations) respond well to treatment and your symptoms will return to your usual level after about 7-10 days.
But exacerbations of COPD can be very serious. They may make you very unwell and need urgent or even emergency hospital treatment.
About 3-4 people in every 100 admitted to hospital because of an exacerbation of COPD will die due to that illness. The risk of death is greater for people who need admission to the Intensive Care Unit (ICU) when in hospital.
Exacerbations of COPD can also accelerate any gradual worsening of your usual COPD symptoms after the exacerbation has resolved, especially if the exacerbations occur frequently. They can also greatly restrict your activities and so reduce your quality of life.
Further reading and references
Chronic obstructive pulmonary disease; NICE Clinical Guideline (June 2010)
Global Strategy for the Diagnosis, Management and Prevention of COPD; Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2017
Chronic obstructive pulmonary disease; NICE CKS, September 2015 (UK access only)
BTS Guidelines for Home Oxygen Use in Adults; British Thoracic Society and BTS Home Oxygen Guideline Group (2015)
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