How To Prevent Another Chest Infection
What To Consider?
Background
Individuals with COPD who have experienced a flare-up (exacerbation is the medical word) want to prevent another one. As described in Chapter 7 of my book, “COPD: Answers To Your Most Pressing Questions Aboot Chronic Obstructive Pulmonary Disease,”there are simple things to reduce the chances of having another flare-up.
First and most important, do not smoke and avoid inhaling irritants (dust, smoke, fumes, etc.) in the air. Second, be up to date on influenza (flu), pneumonia, and COVID-19 vaccines. Third, regular exercise or participation in a pulmonary rehabiliation program have been shown to reduce the risk. Fourth, various inhaled medications have been approved by the US Food and Drug Administration that reduce the chance of flare-ups.
A Patient
JP is a 76 year old female in my practice who has very severe COPD. Her forced expiratory volume in one second (FEV1) is 29% of the predicted value for her age and height. She reports feeling “our of air” walking room to room in her mobile home. In the past five months, she has had at least 4 chest infections. With each episode, she coughs up yellow mucus from the chest, has wheezing, and feels “like crap.” She either sees her primary care professional or goes to the nearby Urgent Care for medical care. The usual treatment is an antibiotic and prednisone, which help
Her current COPD medications are arformoterol solution twice daily and revenfenacin solution in the morning in a nebulizer and albuterol-ipratropium Respimat used as needed – typically 2-3 times per day. She uses oxygen 24/7 @ 3 liters/min pulse flow rate with an oxygen saturation = 93%.
Conditions To Consider
Aspiration
Occurs when food, saliva, liquids, or vomit slips into the lungs instead of being swallowed into the esophagus and stomach. This can cause damage to the lining of the breathing tubes and lead to a chest infection.
Bronchiectasis
a chronic lung condition in which the walls of the large airways (breathing tubes) become damaged and widened. It is common for mucus to collect in these dilated airways that allow bacteria to grow and cause recurrernt chest infections. The best way to diagnose this condition is a CT scan of the chest.
Other conditions to consider include:
Common Variable Immune Deficiency (CVID) – immunoglobulins, also known as antibodies, are proteins produced by plasma cells that are a critical part of body’s immune response to fight infections. A person with a low number, or deficiency, of Immunoglobulin G are more susceptible to bacterial infections in the lungs (bronchitis and pneumonia). This condition is diagnosed by blood tests that measure the level of immunoglobulins (A, G, and M) in the body. Treatment is administration of concentrated amounts of immunoglobulin G intravenously once a month to build up the body’s levels.
Sources of Vitamin D – a pill, salmon, and sunshine
Vitamin D deficiency – This vitamin is responsible for increasing intestinal absorption of calcium, magnesium, and phosphate. It also boosts the body’s immune system and reduces inflammation. The major natural source of Vitamin D is the skin that is dependent on exposure to ultraviolet rays from the sun. Only a few foods, such as fatty fish (salmon and tuna), contain significant amounts of vitamin D. Vitamin D deficiency has been associated with worse lung function and increased odds of a COPD flare-up. This condition is diagnosed by measuring vitamin D levels in the blood.
My Comments
JP did not believe that she was aspirating with eating, drinking, or during sleep. A recent CT scan did not show bronchiectasis.
I ordered blood tests which showed normal levels of Immunoglobulin A, G, and M, while her 25-hydroxy vitamin D2 and D3 level was 17 (markedly reduced). This result confirmed a diagnosis of vitamin D deficiency.
When questioned, JP noted that she did not go outside very often (limited exposure to the sun), did not eat foods rich in vitamin D (salmon and tuna) or foods fortified with vitamn D (milk and many breakfast cereals). I recommended that she start Vitamin D3 pills at 1,000 – 2,000 units per day available at pharmacies and nutrition stores. I explained that taking vitamin D would hopefully improve her over health and more importantly, prevent future COPD flare-ups.
If you experience two or more flare-ups over several months, I encourage you to share this information with your health care professional and ask whether you should be tested for any of the four conditions listed above.