Flair ups of COPD are a major cause of hospitalizations, readmissions, and mortality. It makes sense to develop ways to help patients prevent these events. Some of the preventive measures need to be taken by the patient. These measures include smoking cessation, avoidance of situations associated with exposure to infections and compliance of daily medications. Physicians also need to know when patients are experiencing increased symptoms so that we can provide increased medication help.

The standard treatment for most COPD exacerbations is a course of antibiotics and steroid therapy. It is also important that this treatment plan be followed up if symptoms persist. Patients often ask if they can have a supply of medications to begin when an exacerbation occurs. This is a reasonable plan if patients are taking a trip and want some protections when away. However, I am concerned about allowing self-medication for all patients.

Researchers have been looking at the possibility of vaccinating COPD patients against exacerbations which are most often cause by an increase in bacterial load secondary to a viral infection. So far, the vaccines developed have been found to help with certain bacterial components of exacerbations, but the viral triggers are numerous and have not been classified. Therefore, at the moment treatments for flair ups remain as described although some patients do better when antibiotics are used on a regular basis such as every other day or for a prescribed period monthly.

The search continues for the best approach for COPD exacerbations.