Tips For Avoiding Acute Exacerbation Of COPD or Chronic Obstructive Pulmonary Disease

In this blog, we will review a few simple things that the patient and the patient’s family with chronic obstructive pulmonary disease (COPD), emphysema, and chronic asthma may use to prevent COPD exacerbations.

Many patients with COPD may have underlying chronic asthma and many are active or
former smoker.  Many may have associated emphysema in conjunction with intermittent symptoms of asthmatic bronchitis. Preventing a flare-up of COPD and/or underlying asthma may further help improve quality of life and may decrease use of acute care/hospitalization.

(1) Understanding severity of disease. One needs to understand underlying severity of COPD if underlying bronchial asthma or emphysema is present or not. There are no specific COPD cures, but controlling the symptoms helps improvement of respiratory symptoms and sense of wellbeing. One may consider pulmonary function test if not done to assess underlying severity.

(2) Understanding of acute or chronic COPD symptoms. Keeping a log of regular COPD symptoms and any changes may help to seek early medical treatment for control of COPD exacerbation in the early phase rather than later. The patient may get low-grade fever, increase in cough, quantity, change in the color, and/or increase shortness of breath.

(3) Home oxygen use. A few patients with COPD may need use of oxygen either at night or on exertion or continuously. This needs to be evaluated by their physician.

(4) Emergency plan. It would be good to have an emergency plan if there is worsening of the symptoms. If someone with severe asthma and/or COPD, it may be good to have a course of antibiotic and a tapering course of prednisone handy and start it with exacerbation of symptoms in conjunction with their primary care and/or pulmonologist. If there is worsening of COPD then it would be good to call 9-1-1 and go to the Emergency Room.

(5) Anxiety symptoms. Anxiety, COPD, asthma, emphysema symptoms go hand-in-hand.  With the change in respiratory symptoms and an increase in air hunger there may be fluctuation in anxiety and depression symptoms. Relaxation is the key. Slow deep breathing exercise may help.

(6) Exercise. Regular walking, breathing exercises and moderate strenuous exercise, depending on heart condition may be considered based on physician advice. This has been shown to decrease exacerbation of COPD, and clearing of respiratory secretions in the morning.

(7) Avoiding certain foods. Usually cold water, cold drinks, dairy products, ice cream, and chocolate may trigger underlying COPD/asthma. Bananas increase mucus formation.  This may be good to void. Many patients notice a change once they cut down the use or discontinue it.

(8) Medications. Use of inhalers, nebulizers, oxygen, its duration frequency and maximum dose, needs to be understood. The common mistake many COPD patients make is overuse of long-acting bronchodilators in place of short-acting inhalers or nebulizer treatment. This needs to be avoided. Correct inhaler technique is the key.

I hope this may help in understanding underlying symptoms of COPD and exacerbation factors and cut down any major flare-up.

Bronchial Asthma Assessment And Methacholine Challenge Test

In this blog, we will look into methacholine challenge test and its importance and assessment of bronchial asthma.

Bronchial asthma is a reversible airway disease where there is an increase in FEV1 of 12% and  increase of 200ml post  bronchodilator in a pulmonary function test.  The same may be true for FVC (force vital capacity).

In many situations there is a question if someone currently has asthma or not.  Methacholine challenge test may help in assessing if somebody does not have asthma, especially if the methacholine challenge test negative.  It has a negative predicted value; meaning, if the test is negative then the chances of having underlying bronchial asthma would be less likely.  If the test is positive, it does not mean that the person has asthma and it may be other conditions like postnasal drip, gastroesophageal reflux disease, sinus congestion, etc., that may give a falsely positive methacholine challenge test.

Methacholine challenge test is performed in increasing concentrations of challenge with methacholine and if the highest concentration of 16 mg/ml does not show any bronchospasm then the underlying likelihood of bronchial asthma would be less likely.

Chronic asthma symptoms may be evaluated with methacholine and if the methacholine test is negative then it would make underlying bronchial asthma less likely although the person may be experiencing asthma-like symptoms and it could be related to other symptoms like postnasal drip or gastroesophageal reflux disease. A complete pulmonary function test needs to be performed or at least a spirometry with and without bronchodilator needs to be performed prior to the assessment of methacholine challenge test.

In summary, methacholine challenge test is an important test assessment of bronchial asthma and if there is a question of presence of an asthma or not, a negative methacholine challenge test may help in ruling out underlying bronchial asthma.  The positive methacholine challenge test needs to be clinically assessed for the likelihood of underlying bronchial asthma.

Pulmonary Function Test -Understanding Its Basics

In this blog we will briefly see what the pulmonary function test is, how it can help patients with asthma and other underlying lung conditions without going into very technical details and numbers.

 The pulmonary function test is a very unique test to assess the functionality of the lung.  If the chest x-ray of the person is the anatomy of the lung then the pulmonary function test is the physiology function of the lung.  It is like an electrocardiogram (ECG) of the lung to some extent, but not fully.

 The pulmonary function test is a test where one can assess the mechanics of the lung, the lung volumes, the diffusion capacity and airway resistance.  Whether the test is normal or abnormal needs to be looked into upon comparison with the person’s age, sex, race and height.  Weight generally does not have any relation in this calculation.  The numbers that come out in the test are compared with the reference numbers based on the protocol that is used.

 The pulmonary function test has components like spirometry, which is a common part of the test, generally done in a doctor’s office to quickly assess underlying obstructive or restrictive lung disease.  Obstruction lung disease is where there is obstruction of the lung either from asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis or a combination of the disease, etc.  The restrictive lung disease is where there is restriction of the lung, meaning it has become shorter or smaller in size.  Many times it may truly not be decreased but could be from body habitus and weight gain in most patients, but in conditions like pulmonary fibrosis, the lungs may shrink and may give restrictive lung disease.  The lung volumes are generally used for assessment.  Diffusion capacity is also one of the components to see how much of the diffusion of carbon monoxide occurs.

 Generally, in the spirometry component there is forced expiratory volume in first second (FEV1), forced vital capacity (FVC) and the ratio of FEV1/FVC are the common numbers that are used.  Generally, numbers ranging between 80 and 120 predicted for FEV1 and FVC is considered normal.  This gives an idea about if someone has underlying obstruction or restriction and based on the ratio of FEV1 upon FVC. If the FEV1 and FVC are decreased and the ratio of FEV1 and FVC is normal then it has restrictive changes. It will be obstructive changes if the ratio of the FEV1 and FVC is decreased.  In lung volumes, the TLC or total lung capacity is used and generally it is also between 80 and 120% of the predicted.  When numbers are falling out of this range, generally the pulmonary function test will be read as abnormal.

 The pulmonary function test helps to assess the severity of asthma or COPD or any other underlying condition like pulmonary function test, interstitial lung disease, etc.  A smoker should consider having a pulmonary function test if not done to assess and obtain a baseline of his or her lung capacity.  When a good bronchodilator response is seen on the pulmonary function test, it generally has a relation with underlying bronchial asthma.  A pleuritic assessment of lung disease can be performed either with complete pulmonary function test or with just a spirometry component of the pulmonary function test to monitor underlying lung disease.  The person with bronchial asthma or COPD, emphysema, and is on inhalers or nebulizer if they do not have a pulmonary function test performed then they may consider having the test to assess and obtain a baseline and periodically may be performed as clinically indicated to assess the progression or stability of the disease.

 The technique of the pulmonary function test is very important and a good cooperation with a respiratory therapist is key, otherwise the pulmonary function test may be a suboptimal test as it is an effort dependent test.

For patients with asthmatic bronchitis or bronchial asthma symptoms, who are on bronchial asthma treatment and been clinically  monitored, Pulmonary function test may help the monitoring of bronchial  asthma . In patient with chronic asthma as their asthma improves  its asthma  treatment  can be monitored  periodically with the pulmonary function test. Similarly patient with Emphysema on treatment can be monitored.

 To summarize this article, a pulmonary function test is a key lung test for patients with asthma, COPD and other lung disorders to help establish a baseline and assess the progression and/or stability of the disease if done periodically.  It is an effort dependent test so it needs to be done with correct technique otherwise may give rise to false results.  A good bronchodilator response seen on the pulmonary function test may be associated with patients with bronchial asthma.  Smokers may consider having a baseline pulmonary function test if not done.