By Dr. Jennifer Chambers, MD

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are chronic respiratory conditions characterized by symptoms like cough, wheezing, chest tightness, and shortness of breath, significantly impacting quality of life. These conditions often coexist with comorbidities such as cardiovascular diseases, diabetes, and anxiety/depression.

Repeated exacerbations of asthma and COPD create a vicious cycle. These exacerbations, marked by debilitating shortness of breath, reduce physical activity, negatively affecting cardiovascular health and insulin resistance. Steroid treatments for exacerbations, like prednisone, can further impact the body by affecting appetite, blood sugar, blood pressure, and mood, worsening preexisting conditions like diabetes, hypertension, obesity, and anxiety/depression.  Lets explore the vicious cycle further.

Understanding Exacerbations

Exacerbations are episodes where asthma or COPD symptoms suddenly worsen, often requiring emergency treatment. Triggers include infections, allergens, pollution, or other stressors, leading to increased airway inflammation and symptoms like shortness of breath, coughing, and wheezing.

Impact on Comorbidities

1. Systemic Inflammation: Persistent systemic inflammation from repeated exacerbations can worsen cardiovascular conditions like heart failure and ischemic heart disease, and exacerbate diabetes by affecting insulin sensitivity and glucose metabolism.

2. Increased Medication Use: Managing exacerbations often involves corticosteroids, which can lead to side effects like osteoporosis, hypertension, and increased blood sugar levels, complicating diabetes and cardiovascular diseases.

3. Physical Inactivity: Frequent exacerbations reduce physical activity due to breathlessness and fatigue. This inactivity is a risk factor for comorbidities like obesity, cardiovascular diseases, and depression, and can lead to muscle wasting and decreased fitness.

4. Psychological Stress: The stress and anxiety from frequent exacerbations can worsen mental health conditions like depression and anxiety, negatively impacting the management of other chronic conditions.

5. Healthcare Utilization: Repeated exacerbations increase healthcare utilization, including hospitalizations and emergency visits, leading to higher healthcare costs and financial stress, indirectly affecting the management of comorbid conditions.

To break the vicious cycle of exacerbations in asthma and COPD, a comprehensive management approach is essential:

• Regular Monitoring: Detect early signs/symptoms of exacerbations to prevent worsening through early intervention.

• Personalized Treatment Plans: Address respiratory conditions, social needs, and self-management education.

• Lifestyle Modifications: Provide wellness coaching to encourage physical activity, a healthy diet, and smoking cessation.

• Mental Health Support: Provide psychological support and counseling given the high risk of depression and anxiety experienced by folks living with chronic lung disease.

The Nightingale Virtual Respiratory Care Program embodies these principles. It uses a whole-person approach with a discreet wearable device that collects data on symptoms, biometrics, and activity. Supported by respiratory therapists and self-management education, this program identifies symptom changes early, allowing timely interventions to prevent exacerbations.

Preventing exacerbations reduces healthcare costs and improves the management of comorbidities affected by systemic inflammation and steroid use. By understanding and addressing the mechanisms behind exacerbations, programs like Nightingale can enhance the quality of life for patients with asthma and COPD and decrease healthcare costs related to preventable exacerbations.