COPD is a chronic disease with repercusions beyond lungs. Patients may understand this concept but they may also forget the possibility of getting worse sometimes. How a patient can recognize a deterioration early and avoid worsening of their disease is a key element in their education. Admonishing a patient or relatives because they didn’t come before the worsening is not a solution.
Let’s contribute to the accretion in their understanding of their disease.
Exacerbation in COPD
Exacerbations have been defined in many ways. Three definitions have become popular in the medical arena sometimes to consider a hospital admission. Anyone of them support decisions regard to treatment and potential changes in lifestyle.
Few words and some clarity
One of the definitions of Acute Exacerbation of COPD or COPD Acute Exacerbation (COPD-AE in most clinical trials) is very simple. Dr. Roberto Rodriguez-Roisin from Barcelona, Spain has been a good contemporary analyst of COPD-AE. In his paper published in Chest 2000 May;117(5 Suppl 2):398S-401S, Dr. Rodriguez-Roisin opened the abstract giving a typical patient’s perspective: “an acute worsening of respiratory symptoms”. However, trying to reach a consensus at a workshop they defined COPD-AE as follows: “a sustained worsening of the patient’s condition, from the stable and beyod normal day-to-day variations, that is acute in onset and necessitates a change in regular medications in a patient with underlying COPD”.
The typical COPD-AE symptoms
In the 1980s, Nicholas R. Anthonisen (one of the most identified specialists in the field) based his definiton based on increased intentisity of symptoms, number of symptoms, and systemic response. This approach helped to categorize COPD-AE into types that were numbered (I, II, III) if the were increases in symptoms (dyspnea, sputum volume, sputum purulence), combination of them, and/or other associated non-respiratory symptoms. (Annals of Int Med 1987;106:196-204).
Say Yes or No
Two major criteria or one minor plus one major during 3 days is an COPD-AE according to East London Cohort (Am J Resp Crit Care Med 2000 161;1608-13). The major criteria considered by them are: increased cough, sputum volume, purulence, and dyspnea. The minor criteria are wheeze, fever, and cold symptoms.
What the patient should know
What is clear is that COPD-AE can be recognized according to changes in symptoms and how they are also reflected in the whole body. Patients may be trained to know that they have the symptoms they easily mention and some of them may vary in a day to day basis. However new respiratory symptoms, sustained worsening of those already existing, and new non-respiratory symptoms may preclude a COPD-AE and should be followed up in the short term.
Let’s see any change as something new but not necessarily as something to accept but to adapt in order to have positive outcomes.