Thursday, May 8, 2008

What is a Pulmonary Exacerbation?

Pulmonary exacerbation [pull-moh-NARE-ee eks-a-sur-BAY-shun] is defined simply as a temporary worsening of the lung function due to an infection or inflammation. Although no formal definition exists, an exacerbation is generally characterized by the following symptoms:

1. Shortness of breath
2. Fatigue
3. Increased cough
4. More productive cough
5. Drop in FEV1 or other markers of the pulmonary function tests

There is really no way to categorize what constitutes an exacerbation for everyone with CF. Generally, if something is happening that feels out of the ordinary with regard to breathlessness or lung health, then it might be an exacerbation. In adults with cystic fibrosis, P. Aeruginosa is most often the cause of a pulmonary exacerbation, and is diagnosed with a sputum culture.

Exacerbations or "Flare Ups" associated with lung disease in cystic fibrosis are the body's way of asking for help. A doctor may diagnose an exacerbation by listening to the lungs for any unusual crackles or wheezes, and looking at comparative pulmonary function tests.

Some people with cystic fibrosis experience exacerbations at rather predictable times in the year. For some, seasonal allergies can bring about a flare. For others, it's humidity. For still others, an exacerbation may be caused by an upper respiratory infection or pneumonia.

Treating an Exacerbation

Cystic fibrosis specialists usually like to treat an exacerbation initially with a short course of prednisone. CF patients who have an asthma in addition to CF most often benefit from these corticosteroids. Bronchodilators are also useful to open up tightened airways.

In moderate exacerbations where the FEV1 drops more than a few mL from the normal baseline PFTs, oral antibiotics or inhaled antibiotics such as TOBI, Tazicef or Colistin might be prescribed. The more serious exacerbations that occur with fungal infections or bacterial infections may require a "tune-up" in the hospital where the patient can benefit not only from medication, but additional chest physiotherapy, a monitored diet and, when possible, rest.

Positive Information

It's important to remember that an exacerbation is not necessarily the precursor to declining health. People who experience predictable flare-ups at certain times of the year benefit from doing preventive tune-ups to help them enjoy longer periods of good health with relatively few symptoms. Also, just because a cystic fibrosis patient experiences an exacerbation, it doesn't mean that they have been colonized or infected with a new type of bacteria. It could simply be that an existing bug is growing too fast for the body to fight without antibiotic intervention.

An Eye to the Future

Cystic fibrosis researchers are still studying the link between exacerbations, their severity, and antibiotic therapy. Clinical trials for certain types of inhaled antibiotics are ongoing. The hope is that preventing exacerbations rather than just treating them will greatly improve the quality of life and mean survival age of people with CF.

1 comment:

Matt Todd said...

Good information about exacerbation. I think another good thing to point out is that in a lot of cases, for me at least, they are most often treated with IV antibiotics. In my case at least the inhaled antibiotics that you mention are used more for a maintenance purpose and when the exacerbation comes they hit them with the big guns, the IV antibiotics. Also another aspect that can improve the quality of life for the CF patient with a more mild exacerbation, maybe more in adults, is that IV antibiotics will often be done at home instead of a prolonged hospital stay. I've often gone in and had a PICC place as an outpatient and gone home and begun the antibiotics that evening. But exacerbation's are such a complex and varying thing that their severity and the way they are treated can really vary greatly from person to person. That's just mostly my experience. Good article.