Chronic Obstructive Lung Disease - Complications

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Acute Exacerbations

Acute exacerbations are episodes that occur when the airways suddenly become blocked and symptoms get worse. These events are associated with inflammation in the airways and are generally triggered by an infection in the airway or throughout the body.

Other factors that can trigger serious lung events include:

• Certain medications
• Exposure to irritants in the air (air pollution)
• Seasonal changes (hot weather)

Acute exacerbations include the following symptoms:

• Increased phlegm
• Thicker and darker phlegm
• Shortness of breath (this is the most common and distressing acute symptom)

Acute exacerbations occur, on average, between two and three times a year in patients with moderate-to-severe COPD. They are most often triggered by infections. Smokers have more episodes than nonsmokers. Researchers have discovered that a clot that blocks an artery in the lung (a pulmonary embolus) is present in as many as a quarter of all COPD exacerbations. COPD patients are at higher risk for embolisms than the general public.

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Acute exacerbations get better on their own, but they are still the most common cause of hospitalization in COPD patients. Frequent episodes cause lung function to deteriorate quickly. Patients never recover to the condition they were in before the last exacerbation.

Reduced Quality of Life and Mood

Nearly half of COPD patients report some limitation in daily activities. They have trouble walking up stairs or carrying even small packages. Breathing becomes hard work. More than half of patients with COPD have difficulty sleeping (insomnia). Such impairment in quality of life can negatively affect mood.

Those with COPD are more likely to have anxiety, depression, or another psychiatric disorder than people in the general population. Women with COPD are more susceptible to psychological problems than men.

If patients with COPD become anxious or depressed, they may have a poorer outlook than people without emotional problems. Depression and anxiety are associated with an increase in the frequency and length of exacerbations, as well as the number of hospitalizations. Having anxiety can cause exacerbations to last twice as long as they would otherwise. Depression also increases the risk of death in both those with stable COPD and in those with uncontrolled disease. Having depression may prevent people with COPD from eating properly, exercising, taking their medication as prescribed, and getting the medical attention they need.