Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
Please can you explain what a chronic obstructive pulmonary disease (COPD) flare-up or (exacerbation) is?
Dr. Han: During a flare-up, symptoms of a patient’s COPD worsen significantly, and breathing becomes more difficult. A persistent increase in shortness of breath, cough and sputum production are typical symptoms.
How many COPD patients experience exacerbations?
Dr. Han: Exacerbations are common in COPD, and many patients will have one as their disease progresses. Typically, the more severe a patient’s disease, the more likely he or she is to experience more frequent and severe flare-ups.
Can you tell me about the COPE (Chronic Obstructive Pulmonary Experience) survey and what it revealed about patients’ knowledge of flare-ups?
Scott: The COPE Survey, which was conducted by the COPD Foundation with support from Forest Laboratories, was a two-part national survey of over 1,100 patients and 200 physicians.
The survey aimed to indentify the unmet needs among chronic obstructive pulmonary disease (COPD) patients and revealed that there is a disconnect between patients and physicians when it comes to communicating about the disease.
Some of the most surprising findings from the survey included the fact that patients in this survey reported experiencing symptoms for an average of 2 years and 9 months before they were diagnosed—this shows the need for earlier detection and diagnosis of COPD. Individuals at risk for COPD need to have a dialogue with their doctors regarding appropriate diagnostic testing including spirometry.
The survey also showed a lack of knowledge about exacerbations, a leading cause of hospitalization in the U.S. Nearly two-thirds of the patients surveyed admitted to not knowing a lot about flare-ups and an additional 16 percent were unaware of what one even was. Therefore, it is important that patients and physicians discuss these events and know what steps to take when they are experiencing one.
What warning signs signal that a flare-up is about to occur? Do these differ between individuals?
Dr. Han: The most common causes of COPD exacerbations are infections and environmental triggers such as air pollution and allergens, but there are also times when no clear cause can be identified.
Early warning signs of an exacerbation may differ from person to person. Sometimes patients may think they are developing a cold. However, flare-ups are associated with a persistent increase in symptoms beyond typical day to day variation. A persistent increase in shortness of breath, cough and sputum production should lead patients to call their physicians.
Are patients who have had a flare-up more like to experience another one?
Scott: Yes. Once a COPD patient has an exacerbation, they are more likely to experience another one. That is why it is important for COPD patients to recognize the signs and symptoms of an exacerbation early so that they may be able to properly manage their condition and prevent the frequent occurrence of flare-ups.
Do exacerbations cause lasting damage to the lungs?
Scott: Evidence shows that poorly controlled COPD will cause a rapid loss of lung function toward the end of one’s life. This can be avoided.
The COPE survey showed that COPD patients knew very little about exacerbations, or flare-ups, which can occur as a result of their disease. Raising awareness amongst patients about COPD management is a step in the right direction to help prevent flare-ups from occurring and preserving lung function as much as possible. This simple form of education directly impacts patients’ quality of life.
Can flare-ups be prevented?
Dr. Han: There are treatment strategies patients can discuss with their physician to help prevent flare-ups. Unfortunately, as Scott mentioned earlier, once you have an exacerbation you are more likely to experience another one so it is important to be able to recognize the signs and symptoms early so that the appropriate steps can be taken to manage the flare-up and reduce the likelihood of recurrence.
The COPE survey found that 62% of patients admitted to not knowing very much about COPD flare-ups. What do you think needs to be done to improve patients’ knowledge of exacerbations?
Scott: Educating patients about COPD and exacerbations is extremely important. With the help of educational campaigns like More Matters with COPD, we are hoping to provide patients with the resources they need so that they can talk to their doctors and make sure that they are properly managing their condition.
How important is it to have an action plan in place to manage COPD flare-ups?
Scott: Having an action plan in place is very important in managing flare-ups. COPD patients should work with their doctors to create an action plan which can help a patient determine what actions to take depending on the symptoms they are experiencing.
Depending on their symptoms, patients may be able to manage some exacerbations at home with their current medications by increasing the dose. More severe flare-ups require a visit to the doctor for an evaluation and change in medications or a visit to the hospital for observation and more aggressive treatment.
An action plan can help patients determine what best course of action to take to manage their COPD flare-ups. Early warning signs of a flare-up that should be reported to the doctor right away include: fever, increased use of rescue medications, change in color or amount of mucus, tiredness lasting more than one day, or ankle swelling.
Dangerous warning signs that require a visit to the emergency room or a call to 911 include: confusion, severe shortness of breath or chest pain and blue color to the lips or fingers.
What do you think needs to be done to improve patient care?
Dr. Han: I think some patients may not know what treatment options are available which can include not only medications but also things like pulmonary rehabilitation, supplemental oxygen or even surgical options in severe cases. This emphasizes the importance of establishing good communication between patients and their providers to develop an individualized treatment plan for each patient.
Where can readers find more information?
Scott: For more information about COPD and exacerbations, go to MoreMatterswithCOPD.com. Please note that you can also register on the site and for every person that registers, Forest Laboratories will donate $5 dollars to the COPD Foundation up to $10,000 dollars.
About Dr. MeiLan Han and Scott Cerreta
Scott Cerreta, B.S., R.R.T. is Director of Education for the Chronic Obstructive Pulmonary Disease (COPD) Foundation. He has been instrumental in developing multiple programs for COPD and tobacco prevention education, including the COPD Specialist Course, the Brief Tobacco Intervention Skills Workshop and the Pulmonary Education Program with "On Track with COPD," a peer coaching curriculum.
Cerreta is a registered respiratory therapist with a degree in Cellular Biology and Physiology from Arizona State University. He has written several peer-review articles on smoking cessation and respiratory pharmacology and is a co-author for a manuscript publication – a "Guide for Diagnosis and Management of COPD" published in the Journal of COPD. In addition, he is in high demand for speaking to groups across the country about the disease and resources offered by the COPD Foundation
As a Hospital Corpsman in the United States Navy, Cerreta was awarded three Navy Achievement medals and Sailor of the Year honors at U.S. Naval Hospital, Naples, Italy. In 2010 he received the prestigious Arizona Society for Respiratory Care, Practitioner of the Year award for his outstanding work on COPD throughout the state of Arizona.
MeiLan Han, M.D., M.S. is a board-certified pulmonologist and Associate Professor of Internal Medicine at the University of Michigan Health System, Medical Director of the Women's Respiratory Health Program, and Co-Director of Pulmonary Rehabilitation.
Dr. Han’s research interests include chronic obstructive pulmonary disease (COPD) and interstitial lung diseases including idiopathic pulmonary fibrosis (IPF). In particular, she is an investigator for several National Institutes of Health clinical trials including COPDGene, Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS) and the COPD Clinical Research Network.
Dr. Han is also an associate editor for the journal Thorax and serves on the scientific advisory committees for the American Lung Association, American Thoracic Society and COPD Foundation.