Earlier this month, we talked about how to figure out if a flare-up in symptoms was just a bad day or a full-on exacerbation. My friend Amanda gave some tips on things you can do to avoid flare-ups in general. She also had some advice about when to call your health care professional (HCP) for help. But how does your HCP know what to do when you call? Just like you, they turn to the experts! In this case, that means the Global Initiative for Chronic Obstructive Lung Disease, or GOLD. GOLD is the international expert group that reviews new research every year and makes COPD treatment recommendations based on that research. The latest report has a new way to look at flare-ups that should eventually point us all toward better ways to detect and treat them.
We usually have to wait until after a flare is over to figure out how bad it was. Looking at exacerbations after the fact can be useful for researchers looking at treatments, but it does not really help health care professionals to decide when to start those treatments. People experience flares in many different ways, too. That makes it hard to make consistent recommendations. So, a group of leading lung experts from around the world wanted to find a better way. The group was planning to meet in Rome, Italy during January 2020. Due to the COVID pandemic, they switched to online meetings. Over the next year, the group met several times to review and discuss current research, hoping to find ways to put objective numbers to symptoms to standardize care.
The result was the “Rome Proposal,” named after the original host city. The research group was able to find 6 factors that seemed to show how bad a flare-up was. Breathing rate and heart rate are two of the most obvious ones. They also used the “visual analog scale” for shortness of breath. You probably know this better as the “pain scale” with faces representing different pain levels. The scale has also been shown to let people better explain their shortness of breath to clinicians. Rounding out the list are things like pulse oximetry, the carbon dioxide level in one’s blood (taken via an arterial blood gas sample), and the amount of C-reactive protein (CRP) in one’s blood. CRP is a marker of inflammation throughout the body, and the team discovered that inflammation has a big impact on how bad a flare-up is.
The researchers then assigned warning levels for each. For example, a breathing rate of faster than 24 times per minute was considered a red flag. If someone has symptoms of a flare but none of their values hit those red-flag marks, that exacerbation is labeled “mild.” Someone who has at least three values above the cutoff has a “moderate” exacerbation. If someone then also has worrying blood gas numbers, that exacerbation is “severe.” Figuring out how bad a flare is can help clinicians decide the best time (and place) to give treatments. For example, someone having a moderate exacerbation may need to be admitted to the hospital so they can have a noninvasive ventilator help with their breathing efforts. Someone with a mild flare may be able to be treated at home with extra medications.
There is still a long way to go to answer all the questions about exacerbations. The Rome Proposal itself still needs to be studied to make sure the research team’s assumptions and conclusions hold up in the real world. The good news is, we are one step closer to a more complete understanding of why some flare-ups are worse than others, when a bad day becomes an exacerbation, and what to do to fix it.
Now it’s your turn! What else should we be researching about exacerbations? What kinds of information would be most helpful to you as you try to avoid these flare-ups? Let us know in the comments!