Ask the Harvard Experts: Prevent COPD flare-ups to improve quality of life

Ask the Harvard Experts: Prevent COPD flare-ups to improve quality of life

By Howard LeWine, M.D.

Q: My father’s doctor recently diagnosed him with a COPD exacerbation. What is this? How can it be prevented from happening again?

A: Smokers and ex-smokers worry most about lung cancer. But another smoking-related disease causes more disability, more days in the hospital and almost as many deaths as lung cancer. The disease is COPD, chronic obstructive pulmonary disease.

COPD includes chronic bronchitis and emphysema. More than 80 percent of people with COPD are current or former smokers. Most are over age 40. Women are more likely to develop it than men. The reason isn’t known, but it’s not because women smoke more. While the gap has narrowed, women still smoke less than men.

The main features of COPD are less flow of air into and out of the lungs, symptoms that usually get worse over time and permanent damage to the lungs and bronchial tubes.

Many people with COPD also go through flare-ups. Doctors call them COPD exacerbations. Typical symptoms of a flare-up include coughing more than usual, a change in the color of coughed-up mucus, increased shortness of breath, wheezing and fatigue.

Preventing COPD exacerbations is important. Compared with COPD patients who have few or no flare-ups, those with frequent flare-ups lose lung function at a faster rate, have a poorer quality of life and die sooner.

Flare-ups happen because the lungs’ airways get infected, inflamed or both.

If your father has COPD and still smokes, he must quit now. Quitting smoking is the only chance he has to prevent the disease from getting worse.

Drugs for COPD cannot slow down the eventual decline in lung function. However, they can allow people to breathe a little easier, with less coughing. They also help prevent COPD flare-ups.

Commonly used drugs for COPD help people in different ways:

1. Corticosteroid inhalers reduce inflammation.

2. Beta-agonist inhalers improve air flow by relaxing the airways. Some inhalers combine a long-acting beta-agonist with a corticosteroid.

3. Anticholinergic inhalers also improve air flow. They have a different way of relaxing bronchial tubes.

(Howard LeWine, M.D. is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)

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