Many COPD patients suffer from acute exacerbations where their symptoms suddenly get a lot worse and can result in hospitalisation. 75% of the time it is due to a lung infection whether bacterial or viral. The most common culprits are the influenza virus and Streptociccus pneumoniae, which cause the flu and pneumonia.
Bacteria and viruses cause infections in different parts of the lung and cause bronchitis if it occurs in the larger bronchial tubes or cause bronchiolitis if in the smaller bronchial tubes. An infection in the alveoli or air sacs of the lungs can cause pneumonia. Antibiotics are only effective against bacterial infections and viruses are more difficult to treat. Often a patient will acquire a secondary bacterial infection from having a viral one. This is due to the build up of mucus and inflammation in the lungs which create the perfect breeding ground for bacteria. This is why antibiotics are normally prescribed whether the infection is viral or bacterial as to protect from a secondary bacterial infection from occurring.
The other common causes of exacerbations are sinus infections, air pollution, heat failure and blood clots. It is so important that COPD patients try to avoid any of these triggers and try to prevent picking up any viruses or bacteria in order to prevent exacerbations.
The disease compromises the lung’s ability to defend against bacteria and a new study has shown that even when a patient isn’t experiencing an exacerbation, the bacteria that are colonized in their lungs are causing respiratory symptoms for them. Having bacteria in the lungs increases the inflammation and significantly increases the shortness of breath, cough and sputum in COPD patients. Doctors are aware that most stable patients experience daily fluctuations in respiratory symptoms but the reason why has never been understood until now. These fluctuations can sometimes be fairly intense and often qualify as exacerbations but go unreported to their doctor.
The study shows that medicine needs to alter its approach to treating stable COPD patients and not to focus on just the flare-ups but to understand that COPD is based around a chronic infection and treat accordingly.
“The lungs are constantly being exposed to microbes ‘with every breath you take’ as well as from aspiration of small amounts of secretions from the throat, especially during sleep,” Dr Sethi says. “If the persistence of these bacteria contributes to increased symptoms and inflammation in the lungs in stable COPD, we should regard this as a chronic infection, not innocuous colonization. For that reason, more must be done to reduce chronic infections in COPD.”
However due to resistance, long-term antibiotic treatment is not the way forward and “we need to put more emphasis on developing therapies that can decrease bacterial colonization in COPD.”
At the end of last year a company announced that the drug AB569 had been successful in trials and appears to be able to treat lung infections caused by Pseudomonas aeruginosa, a common culprit of lung infections in COPD and CF patients. This bacteria is common however it is also difficult to treat as it survives without oxygen and it has the ability to develop resistance against antibiotics as it holds a lot of resistant genes. It causes 40% of infections in children with CF and up to 75% of cases in adults with CF as well as a high percentage of COPD infections. If this drug can treat this bacteria and passes human trials then perhaps it can be used to help dramatically cut the number of infections and the resulting exacerbations suffered by COPD and CF patients and also ease their daily fluctuations of respiratory distress.
Here are eight tips that can help you reduce your risk of developing an infection:
- Wash your hands. Regular hand-washing is one of the most important things you can do to reduce your risk of infection.
- Avoid infections. Ask people who are sick not to visit until they are well again, and wear a face mask if you do have to come in contact with someone who has an infection.
- Clear your airways. It is important to keep airways free from mucus. Your doctor can give you devices and teach you manoeuvres to ensure your coughing is productive at shifting the mucus.
- Stay hydrated.
- Clean your equipment. All equipment that you use, including humidifiers, oxygen masks, and flutter valves, should be properly cleaned and maintained to ensure that they don’t harbour infectious organisms.
- Get vaccinated. Talk with your doctor about which vaccines you should get. In general, people with COPD should get a pneumococcal vaccine once, as well as a flu vaccine every year.
- Stay away from crowds. When possible, avoid large crowds, especially during cold and flu season.
- Treat infections as early as possible. Call your doctor at the first sign of infection, so it can be treated before it progresses to a more serious infection of your lungs.
- Breathe clean air if possible. Breathing in air from your supplemental oxygen unit and air that has been filtered in your home will be a lot cleaner and free from irritants such as pollen, dust and germs and will help to reduce the risk of an exacerbation.