"An ounce of prevention is worth a pound of cure."
~~ Benjamin Franklin
"Stat neb treatment in the Emergency Room - Stat neb treatment in the Emergency Room."
The voice of the ER unit secretary came across my pager. It was 10:00pm on a cool fall night. I walked into ER room six to find Steve, a man in his early 60's, sitting on the edge of the gurney, leaning forward, coughing hard and struggling to breathe. I gave him a hand-held nebulizer, misting with a medicine to open his lungs. He put it to his mouth and breathed it in.
After checking his lungs I patted his shoulder and said, "Not doing too well tonight, are you? Have you been sick for a while?"
"Nope. I was" fine until" tonight. This came" out of" nowhere."
"Hmmmm"" I said. "Have you been coughing any more than usual over the last few days?"
Taking deeper breaths now and a bit more comfortable, Steve paused and then nodded.
"Have you been coughing anything up?"
"Was it different than usual? Did it have color? Was it thick and sticky?"
Steve gave me kind of a dirty look, like I'd asked a weird question - and to anybody outside the respiratory world, it probably was.
Then he said, "Come to think of it" I've been coughing up sticky green stuff" for about a week."
Steve was not a stupid man by any means, nor was he careless. He had quit smoking and took pretty good care of himself, but he had no idea - nobody ever told him - that for him, a person with COPD, a change in his cough and the color of mucous is a major early warning sign of lung infection. If only he had known what to watch for and sought help at the first sign of trouble he'd probably been able to make it through this infection with a day or two off work and some rest at home. Instead he was facing a three-day hospital stay and a week off of work.
As a person with COPD, you have to be on the lookout for early warning signs of acute exacerbation. A cold or flu germ that is a mere inconvenience to somebody with normal healthy lungs can become a major problem for you, possibly leading to pneumonia and serious illness.
There are things you can do to stave off an acute exacerbation of COPD. This is not to say you'll be completely successful in doing so each and every time. But if you know how to avoid troublemakers and what signs to watch for, you'll be in a much better position to minimize illness and keep on living your life.
Steps to Avoiding Germs
Here are just a few of the many things you can do to avoid picking up nasty bugs. I'm sure you can think of others that work well for you.
- Get your flu shot every fall.
- Get a pneumonia shot every 5-7 years depending on your doctor's recommendation.
- Wash your hands with warm water and mild soap. Wash for 15-seconds, the time it takes to sing "Twinkle, Twinkle Little Star." (You don't have to sing aloud)
- Use your own pen. Do you really want to touch that pen (the one everybody uses) at the bank - or worse yet, the doctor's office?
- Wear lightweight gloves or cover the handle of the grocery cart when you shop.
- Carry hand sanitizer with you and use it when you can't wash.
Develop an Action Plan with Your Doctor
Work in partnership with your doctor to stay well. Make an appointment if you don't have one coming up soon. At this appointment, ask:
"When do you want me to call you?"
"Which early warning signs do you want to know about when I notice them?"
"When I call your office, how will your staff know that I'm more likely than many of your other patients to get really sick?"
Know What to Watch For
Knowing early warning signs cannot only help you stay healthy, at home and independent, but it can save your life! Here are some early warning signs of acute exacerbation for people with COPD. Show this list to your doctor and ask if there are any other early warning signs, specific to you and your situation, that he or she suggests you watch for.
- A change in your cough - are you coughing more, less, or is it different than your usual?
- A change in the amount of color of your sputum. Is it yellow, green, or bloody? Your mucous should be clear or white.
- If you have a pulse oximeter at home, are your O2 sats (oxygen saturations) lower than usual?
- Sudden weight gain such as three to five lbs overnight.
- Swelling in your ankles or feet. Here's a tip: Gently press the tip of your finger into the skin around your ankles and feet. Does it leave a dent? It shouldn't. If it does, call your doctor.
- Morning dizziness, confusion, or headache that doesn't go away with meds such as Tylenol or Advil.
- A heart rate faster than usual (60-100 is normal with each person having their own "normal"). Know your normal resting heart rate.
- Your urine should be pale yellow and clear with no odor. If it is darker than usual, cloudy or with a foul odor, you might have a urinary tract infection.
- Unusual fatigue
- Joint or muscle aches
Don't spend this fall and winter on the edge of a COPD exacerbation. Do all you can to avoid infection, catch early warning signs, act upon them right away, and work in partnership with your doctor to stay well.