Early Warning Signs and Prodromal Symptoms of AECOPD Patients

*Buntarika Chatreewatanakul*

## **Abstract**

An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a major problem leading to the most cause of death in chronic obstructive pulmonary disease (COPD) patients. Most cases of AECOPD occurred at home and outside the hospital. The COPD patients have the pattern of AECOPD according to their individual experiences. When the patients had AECOPD, also the warning signs and prodromal symptoms were happened differently. However, the characteristics of warning signs and prodromal symptoms could be described in three categories: 1) early signs and symptoms, 2) signs and symptoms that make the patients worse, and 3) time of occurrence. If the patients have been ill with COPD for a period of time until they can learn his/her early warning signs and prodromal symptoms of AECOPD by themselves or/and with their caregivers or/and with healthcare professionals, they will be able to quickly recognize their signs and symptoms when they occur and will be able to manage them as soon as according to their competency individually.

**Keywords:** early warning signs, prodromal symptoms, an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), chronic obstructive pulmonary disease (COPD), characteristics

## **1. Introduction**

Chronic obstructive pulmonary disease (COPD) is currently a pulmonary problem around the word. It is the third leading cause of death in 2020 [1] and now is one of the top three in 2022 [2]. Most deaths of COPD patients are a cause of worsening of symptoms which it was called acute exacerbation or exacerbation of COPD or AECOPD or COPD flare-up. Exacerbations were cause of respiratory failure that induced the COPD patients to receive life support. Most of AECOPD patients have to receive mechanical ventilator and difficult to wean. It effects to prolong intubation and have low quality of life until those patients die. Moreover, more than 50% of COPD treatment costs were related to exacerbations [3, 4] and they are cause of the slow decline of the disease trajectory that make COPD patients often end of life.

An acute exacerbation can be met in all levels of COPD severity, but it usually occurs in the late stage of it. In 2013, forced expiratory volume in one second (FEV1) is not suggested for categorizing the severities of COPD. In 2016, the exacerbation

was the one criterion that used for categorizing the severities of COPD. Nowadays, only FEV1 is suggested for categorizing the severities of it [2]. AECOPD first appears in GOLD grade 1 and appears most frequently in grade 4. An exacerbation in COPD patients is an acute state of respiratory symptoms that occurs more than normal day such as dyspnea (shortness of breath), cough, sputum, and makes the patients need additional treatment [5–8]. It is similar to clinical trials, it was defined as "an increasing therapy more than regular day or urgent care is needed the using of antibiotics, systemic corticosteroids, or both in the hospital or/and emergency room" [9]. The severity of AECOPD could be classified into three levels: 1) mild, 2) moderate, and 3) severe. First, the mild level is when the COPD patient has an exacerbation but the treatment not change. Second, the moderated level is when an exacerbation occurs, the medication changes. Finally, AECOPD patient must go to the hospital [9, 10].

Most COPD patients unable to remember their AECOPD events. They do not know the signs and symptoms that happen during they face AECOPD state because they have the pattern of AECOPD according to their individual experiences. It is not similar with other COPD patients. They have to know and recognize it by themselves. It seems like AECOPD experiences are quite unclear. If healthcare professional can help COPD patients able to remember signs and symptoms of AECOPD, they will able to manage it successfully and quickly that it does not affect the bad quality of life.
