Chronic Obstructive Lung Disease - Complications

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Acute exacerbations include the following symptoms:

• Worsened shortness of breath. This is the most common and distressing acute symptom.
• Increased volume of sputum, which is also typically thicker and greenish in color.
• Wheezing.

Acute exacerbations occur, on average, between two and three times a year in patients with moderate to severe COLD. In about 80% of the cases, they are triggered by infections. Smokers have more episodes than nonsmokers do. Acute exacerbations resolve on their own, but they are still the most common cause of hospitalization in these patients. Patients with frequent acute exacerbations of COLD are at higher risk for disease deterioration, including reduced quality of life and increasing rates of hospitalizations. Furthermore, in patients who are hospitalized, the morality rates are 11%. Survivors of a first hospitalization have a 50% change of rehospitalization within 6 months.

A new study looked at physical activity levels of patients recovering from an acute exacerbation of COLD. The study found that such patients have very low levels of physical activity while in the hospital and after being discharged. The study found that patients with lower physical activity 1 month after discharge were more likely to be hospitalized within a year, for another episode of acute exacerbation. The researchers recommend adding appropriate amounts of exercise to the treatment of such patients.

Effect on Quality of Life and Mood

Nearly half of patients with COLD report that daily activities are limited. They have trouble walking up stairs or carrying even small packages. Breathing becomes hard work. More than half of patients with COLD often suffer from insomnia. Such impairment in quality of life can greatly impair mood. If patients with COLD become anxious or depressed, they may have a poorer outlook than those without these emotional problems. Even low-level depression can impair health. Of some concern was a 2003 study reporting a higher rate of suicidal thoughts in patients with COLD or asthma than in those with any other major chronic illness, including arthritis, diabetes, heart disease, and cancer. More research is needed on this subject. Certainly, however, psychological interventions may be particularly helpful for people with COLD.

Medical Complications from Oxygen Deprivation

Over time, both varieties of COLD cause low oxygen levels (hypoxia) and high levels of carbon dioxide (hypercapnia) in the body. In order to boost oxygen delivery, the body compensates in a number of ways:

• The rate of breathing increases.
• More red blood cells are produced to increase the blood's oxygen-carrying capacity.
• The heart rate increases to pump more blood.
• Blood vessels in the lung constrict to force blood and oxygen through the circulatory system. This leads to high blood pressure in the lungs (pulmonary hypertension).