5 Signs Your COPD Treatment Isn’t Working
Although there isn’t currently a cure, you can find ways to live with chronic obstructive pulmonary disease (COPD)—thanks to bronchodilators, steroids, pulmonary rehabilitation, and supplemental oxygen. The trick is finding the right treatment plan for you.
“COPD can come in a few different varieties. Some people have just emphysema, some have just chronic bronchitis, and a lot of people have little bits of both,” says Elliot D. Backer, M.D., a pulmonologist at Dartmouth Hitchcock Medical Center, in Lebanon, New Hampshire. So what helps one person manage their COPD may not work for another person.
Meet the experts: Elliot D. Backer, M.D., a pulmonologist at Dartmouth Hitchcock Medical Center, in Lebanon, New Hampshire; Nathaniel Marchetti, D.O., medical director of the Respiratory Intensive Care Unit at Temple University Hospital, in Philadelphia.
It’s up to you to monitor your symptoms and note when things start to worsen. “If you experience a progression of symptoms, and these are persistent, that may be an indication that you don’t have adequate control of the disease,” Dr. Backer says. “That’s a good opportunity to see your primary care provider or be referred to a pulmonologist to look at the medications you’re on and see if areas for improvement can be offered.”
In particular, be mindful of these five signs, which may indicate it’s time to make an appointment to revisit your care plan.
1. Persistent shortness of breath
COPD makes it difficult to breathe because of one or both of following:
The air sacs in the lungs (which exchange oxygen and carbon dioxide with the blood) can’t expand and contract like they used to
Inflammation and mucus narrow the airways
Both of these mean it’s harder to move air in and out of the lungs. People with COPD often don’t notice any difficulty breathing when they’re sitting or lying down. But when they walk a flight of stairs, they may feel like they can’t get enough air in their chest or are suffocating. Or they may discover their stamina isn’t what it used to be, and they have to cut short their normal outdoor walks, or mow the front yard one day and the back another rather than doing both the same day.
For any of these scenarios, “this could be a sign of a flare-up; it could also be an indication that your therapy isn’t working for one reason or another,” explains Nathaniel Marchetti, D.O., medical director of the Respiratory Intensive Care Unit at Temple University Hospital, in Philadelphia. “And in people 60 and older with a history of smoking, there may be other disease processes, such as heart disease or lung cancer.”
2. Increased mucus production
Many people with COPD produce excess mucus (also called phlegm or sputum). Also called chronic bronchitis, this can lead to a buildup in the airways. And you often can’t cough all of it out, because COPD also weakens the respiratory muscles and damages the cilia, the hair-like structures that help clear mucus.
If you feel like you have more mucus than previously, or there’s a change in the color of the sputum, it may indicate you’re having a flare-up or that you have a bacterial infection.
3. Frequent exacerbations
If you experience an intensification of wheezing, mucus production, difficulty breathing, or other symptoms suddenly, and these problems last for two days or longer, you’re having what’s called a COPD flare-up or exacerbation. “You go from feeling crappy to feeling really crappy,” Dr. Marchetti says.
Often caused by exposure to irritants—such as wildfire smoke, air pollution, or dust in a work environment—or by respiratory infections like the flu, exacerbations are common. However, if they’re occuring more often than before, your disease may be progressing, Dr. Backer says. Don’t neglect talking to your doctor about them, as COPD exacerbations are associated with worse outcomes, including more flare-ups and death.
4. Chronic cough that worsens
Cough is a common symptom of COPD, due to the inflammation and mucus in the airways. If it starts worsening, it can increase the risk of exacerbations and mortality, and may indicate your disease is progressing. At the same time, the reasons why your cough is intensifying could be many. Trust your gut: If your cough feels different from normal, see your provider, Dr. Backer says.
5. Recurrent wheezing and chest tightness
Wheezing, which can sound like whistling when you breathe (though you may need a stethoscope to hear it), and chest tightness often go hand-in-hand. This happens because the airways are constricted, and you need to open them up for better airflow. So wheezing that keeps coming back may indicate you need a different inhaler or other medication to dilate your airways. It could also possibly indicate heart problems, which can be diagnosed with testing such as a CT scan of the chest or an echocardiogram.
What to do about these signs
If you notice anything different about your COPD symptoms, make an appointment to see your healthcare provider. This may be your primary care physician, or it may be a pulmonologist. Either way, be prepared to discuss with them what you are experiencing. The best way to do so is to record your daily symptoms in a journal, according to experts, which can make it easier to identify flare-ups versus longer-term issues.
In addition, Dr. Backer suggests establishing a baseline based on how you felt six months, a year, or five years ago, and then comparing that to how you currently feel. “That starts to paint the picture, and we may start to connect the dots of a downward trend,” he explains. “It helps us think about where this is heading and how aggressive we need to be,” in terms of treatment.
At your appointment…
Be prepared to speak to your doctor. Bring your symptom journal, your inhaler(s), and any other medications—for one thing, if you use several, you may forget the names of some of them if you don’t have them with you. For another, your doctor can watch you use them. “Oftentimes, there are tweaks or additions we can give for more effective use,” Dr. Backer says.
When it’s time to discuss what’s happening with your COPD, don’t exaggerate things, but also don’t cover up how your symptoms impact your day-to-day functioning. “The point of inhalers is: Do they make you feel better? Are they improving your quality of life?” Dr. Backer explains. “If not, we may need to keep searching or add to that medication.”
In the end, it all comes down to advocating for yourself. If you don’t feel like your doctor is adequately addressing your concerns, you could say something like, “Things don’t seem to be moving in the right direction—I’m not feeling better.” Then you might ask about:
Other inhalers
Further testing (such as a CT scan of the chest, an ultrasound or echocardiogram of the heart, or a stress test)
A referral to a pulmonologist
Pulmonary rehabilitation
Whether you qualify for free lung-cancer screening
There are usually other treatments that can be offered to lower the risk of disease progression. But you need to be mindful of your symptoms, so you can note when things are off, and then work with your care team to find the solution.
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