It is Important to have Action Plan for COPD Flare-ups


Dr. (Brig.)Ashok Rajput, is a Former HOD-Pulmonology, Army Hospital R&R, HOD-Pulmonology Venkateshwar Hospital,with a robust experience of over 35 years. He has contributed significantly in the field of respiratory and sleep medicine in India and was awarded the prestigious Major General Amir Chand Award in 1988.copd

He has held various leadership positions including Director Pulmonology Fortis Hospital, Head of Department (Medicine & Respiratory Medicine) and AFMC Pune among others. To his credit, he was the first doctor to introduce sleep medicine in the Armed Forces. Dr(Brig) Rajput in an interaction with Ekta Srivastava, Health technology elaborates more on COPD

Can you explain what a chronic obstructive pulmonary disease (COPD) flare-up or (exacerbation) is?

Development of lower respiratory infection, worsening bronchospasm and hypoxemia in a stable COPD patient suggests flare up or exacerbation.

How many COPD patients experience exacerbations?

Most of COPD patients experience exacerbations on exposure to smoke, fog, smog, pollution, viral or bacterial respiratory infection or even stopping regular bronchodilator inhalers.

What warning signs signal that a flare-up is about to occur? Do these differ between individuals?

Warning signs are undue worsening breathlessness, worsening cough, yellow-green sputum, increase in sputum production suggest flare up or exacerbation of COPD. It differs in individuals. Some have predominant emphysema (pink puffers), some have predominant chronic bronchitis (blue bloaters)

Are patients who have had a flare-up more like to experience another one?

Two-three flare ups in a year are common in COPD. Patient can usually experience it in cold weather when air quality is poor like smog or during influenza season.

Do exacerbations cause lasting damage to the lungs?

Every exacerbation causes lasting damage and declining lung function.

Can flare-ups be prevented?

Flare ups can be prevented by regular bronchodilators, influenza and pneumonia vaccination and early institution of antibiotics when infection sets in. Quitting smoking and improving air quality may be additional factors.

What do you think needs to be done to improve patients’ knowledge of exacerbations?

Health education and counseling including pulmonary rehabilitation can improve patient’s knowledge of exacerbation.

How important is it to have an action plan in place to manage COPD flare-ups?

It is important to have action plan for COPD flare-ups. Patient should be given antibiotics at earliest warning signs. Regular follow ups should be done with the doctor. Patient can measure SpO2 by pulse oximeter at home and inform doctor when declining SpO2 or worsening tachycardia along with cough and dyspnea.

What do you think needs to be done to improve patient care?

Quitting smoking, regular inhaler, vaccination, good nutrition, pulmonary rehabilitation, improving compliance by health education, avoid exposure to extreme cold and poor air quality and oxygen therapy for hypoxemic patients are few steps required to improve patient care.

Which is the most appropriate definition for the Pleuroscopy? In other words, what are the characteristics of this procedure?

Pleuroscopy is a procedure in which through a small port one peeps into pleural cavity for taking pleural biopsy. It is done in pleural effusion diagnosis. Usually tuberculosis or malignancies are differentiated by pleural biopsy in exudative pleural effusion by pleuroscopy.

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