Acute Symptoms in Chronic Lung Disease: Knowing When to Call for a Doctor

Your loved one complains of shortness of breath or tightness in the chest. Is it a lung or a heart problem, or something else? Maybe it will go away after a good night's sleep, but what if it worsens during the night? You do not want to leave it to chance and wonder if you should call a doctor, bring your loved one to a clinic, or even the emergency room. 

Situations like this may sound familiar if you are caring for a senior with chronic lung disease at home. It can be overwhelming having to deal with the occasional ‘health scares’ on top of the daily caregiving. In this article, we discuss the common symptoms of chronic lung disease, how to tell the acute symptoms that need urgent professional care from those you can safely self-manage. 

Though this does not substitute medical advice from your doctor, we hope to aid your caregiving or self-care with general guidance and relieve you from unnecessary worry and stress when managing a chronic respiratory disease at home. 

1. Common chronic respiratory disease in Singapore

Chronic respiratory disease refers to a group of medical conditions that persistently affect the airways or certain parts of the lungs. People with respiratory disease have difficulty with inhaling, exhaling, or both. As the condition is chronic, they may easily feel breathless, cough a lot and experience fatigue frequently. They may also be prone to flare ups of asthma, acute infections such as pneumonia, tuberculosis, and other breathing problems. 

By far, the most common chronic respiratory conditions in Singapore are chronic obstructive pulmonary disease (COPD), asthma, and allergic rhinitis. They are all covered under MOH’s Chronic Disease Management Program (CDMP) which allows for medical subsidies of up to $700 per person per year. COPD and asthma can be life-threatening while allergic rhinitis is more of a life nuisance due to the constant blocked or running nose. However, all of them interfere with one of our basic body functions - breathing - which can hinder us from being productive or doing activities that we enjoy. 

To learn more about the causes, symptoms and treatment of COPD and asthma, check out our dedicated article here. We will focus more on managing the acute symptoms of these diseases in this article. 

2. Other chronic respiratory conditions

A number of chronic lung diseases that are less common among elderlies but often require watchful care include:

  • Cystic fibrosis: An inherited disorder in which the body produces thick and sticky mucus that accumulates in the lungs, pancreas or other organs. When cystic fibrosis affects the lungs, it can cause inflammation, blockage, infections and other severe damages to the airways. 
  • Bronchiectasis: This disease is often caused by another lung disease such as tuberculosis, pneumonia or cystic fibrosis. The bronchi’s walls get damaged and enlarged, creating pouches for mucus to gather. Phlegm, persistent cough and shortness of breath are common symptoms.
  • Pulmonary fibrosis: Literally translated as scarring of the lung, this is in many cases the result of exposure to environmental or occupational toxins. The scars in lung tissues result in chronic breathlessness and dry cough. 
  • Pulmonary hypertension: Due to high blood pressure in the lungs’ blood vessels, people with this condition experience chest pain or chest palpitations, progressive difficulty breathing, bluish lips and skin, dizziness, fatigue, among other symptoms.
  • Lung cancer: Due to its extended treatment duration, cancer that starts in the lung is also considered a chronic disease. (Learn more about lung cancer and managing it at home here.)

3. Managing shortness of breath

As you can see from the description of various lung diseases above, a common symptom they all shared is shortness of breath, or dyspnea in medical terms. Due to obstructions along the airways, the lungs have to work harder to move air in and out. As a result, you feel like you struggle to breathe, or that breathing is not fast enough and deep enough.

Often, dyspnea first happens when you engage in physical activities such as climbing the staircase or carrying heavy items. Then it progressively worsens and may occur even when you are resting. So at what point do you or your senior loved ones need to see a doctor? 

The key is to observe if there is a change in the severity of dyspnea. If you feel shortness of breath when doing your usual physical activity, take note and give yourself more rest time. To relieve breathlessness, you can practise self-care techniques such as pursed lip breathing and tripod sitting position. It is important to get familiar with these techniques when you are feeling well, so you do not risk inadvertently making things worse when you need care.

However, contact your doctor immediately, even at night, if symptoms worsen quickly and you experience the following symptoms: 

  • Drastic change in shortness of breath: For instance, you only had difficulty breathing when doing physical activity before but now have breathing problems even when you are sitting down.
  • Feeling so breathless that you have trouble doing simple activities that do not require any exertion.
  • Having such difficulty breathing that you are unable to lie down or sleep.

4. Chronic coughing and phlegm 

Coughing is the body’s natural response to expel mucus, phlegm or other irritants from the throat and airways. In that sense, coughing is a protection mechanism. But it can also cause harmful effects, including spasm and trapped mucus that leads to infection. Long term vigorous coughing can lead to sleep loss, urinary incontinence, haemorrhoids, even broken ribs.

Coughing and phlegm are associated with multiple chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), asthma and pulmonary fibrosis . Similarly to dyspnea, these symptoms need to be monitored closely when there are changes in severity and presence of other symptoms, such as: 

  • More frequent coughing 
  • Coughing sounds more harsh or strenuous
  • More phlegm or mucus
  • Presence of fever

Resting and self-care techniques such as chest physical therapy and controlled coughing may help you feel better. Ask your doctor or respiratory therapist for a demonstration and get familiar with the techniques when you feel well. 

However, contact your doctor immediately if your symptoms do not improve or if you notice the following alarming signs: 

  • Coughing up blood
  • Phlegm or mucus becomes thicker or changes in colour, such as yellowish, greenish, brownish 

These symptoms may signal pneumonia or other serious infection of the respiratory tract. They need to be diagnosed and treated by medical professionals urgently. 

5. Acute respiratory failure

Respiratory failure refers to the inability of the lungs to perform hemostasis correctly after the alveoli (air sacs) have been inundated with fluids. Consequently, the oxygen saturation in the blood decreases sharply, and carbon dioxide (CO2) builds up in the systemic circulation. It may happen to patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, and COVID-19. A history of stroke, heart failure and conditions affecting the nerves and muscles in the lung area can also precipitate this complication.

There are two types of respiratory failure, depending on the levels of oxygen and carbon dioxide found in the blood.

  • Hypoxemic respiratory failure – the patient has low blood oxygen saturation but close to normal levels of CO2.
  • Hypercapnic respiratory failure – this occurs when the patient has physiological levels of oxygen in their bloodstream but higher than normal carbon dioxide.

When respiratory failure is acute, in many cases referred to by doctors as acute respiratory distress syndrome (ARDS), the patient starts experiencing symptoms immediately, which endangers his/her life if not treated promptly. However, many patients can also develop chronic respiratory failure, which requires many accommodations to aid the defected lungs, such as oxygen therapy or ventilator at home. All acute respiratory failure episodes need to be treated urgently by healthcare professionals. 

What are the signs and symptoms of acute respiratory failure?

The clinical presentation of this condition is extremely diverse and depends on the underlying cause, the degree of desaturation, and levels of CO2 in the blood. Below are a number of common signs and symptoms you should watch out regarding each type of respiratory failure:

In hypercapnic respiratory failure (excess CO2):

  • Rapid breathing
  • Bluish lips, nails, hands or skin
  • Neurological symptoms, such as confusion, delirium

In hypoxemic respiratory failure (insufficient oxygen)

  • Restlessness and anxiety
  • Unusual sleepiness during the day or prolonged night sleep
  • Loss of consciousness
  • Rapid breathing
  • Fast or irregular heart rate 
  • Profuse sweating

If your loved one has developed chronic respiratory failure, you may have an oxygen tank or a ventilator at home. Make sure you use them immediately as prescribed by your doctor, while monitoring closely for improvement of symptoms. However, if the patient does not feel better or if this is an acute occurrence, contact your healthcare provider immediately. A delay in seeing a doctor in such cases can increase the chances of complications and duration of hospitalisation. 

6. Pneumonia 

Seniors with chronic lung diseases are at higher risk of catching pneumonia. It can develop from a flu, Covid-19, other bacterial or viral infections, or having food entering the airways due to difficulty swallowing (dysphagia). 

While many cases of pneumonia can be safely treated at home under the supervision of a GP, pneumonia in elderlies with chronic respiratory problems need special attention from family and caregivers. The reason is because pneumonia in elderlies may quickly turn severe with debilitating consequences, even fatality. Complications include acute respiratory distress (ARDS) and respiratory failure, damages to internal organs and sepsis. In fact, pneumonia is among the top 3 killers in Singapore, with people above the age of 65 accounting for more than two thirds of all hospitalisation associated with pneumonia.

Despite being a familiar condition, recognising the symptoms of pneumonia among elderlies can be challenging. Their immune system may not be strong enough to stimulate a powerful inflammatory reaction, resulting in less obvious symptoms. Generally, you can look out for symptoms that are similar to an infection and inform your doctor immediately, including: 

  • Fever
  • Shortness of breath
  • Chest pain
  • Coughing
  • Digestive symptoms (e.g., diarrhoea, nausea, vomiting)
  • Confusion

Pneumonia can be treated at home but always needs to be diagnosed and monitored by medical professionals. Learn more about diagnosis, treatment and prevention of pneumonia in our article here

7. Other Acute Symptoms of Lung Disease

In addition to the above symptoms and complications, contact your doctor or care team if you or your loved ones experience: 

  • A fever
  • Chest pain
  • Swelling in the feet, ankles, legs: known as edema, this indicates fluid build-up in the body, a possible sign the heart is not working well
  • Decreased alertness
  • Increased fatigue
  • Reduced appetite 
  • Increased nausea, headache, dizziness
  • Changes in bowel movements (difficulty passing motion, or dry, hard stool)
  • Unintentional weight gain or weight loss
  • Unexplained loss of sleep or poorer quality of sleep at night
  • Signs of anxiety, depression

Similar to other symptoms we discuss above, pay attention to any changes from the usual status and talk to a family physician for a prompt diagnosis. The symptoms might or might not be related to the lung condition. In any case, early intervention is often associated with better outcomes.

8. The Role of a Regular GP or Family Doctor

As we have written in our article about chronic disease management at home, long-term conditions are often best managed by a core team involving the patient him/herself, the primary caregiver and a regular family physician. Other team members such as nurses, therapists or specialists can be called on when necessary. 

As seniors with chronic lung disease may have other existing medical conditions, it is important that the doctor is aware of the medical history, known contraindications, and care preferences of the patient and family. If you have not had a regular family doctor to care for your loved one with chronic lung disease, it will be beneficial to start having one. Having a primary care contact will help you make important decisions, like when you should not delay taking your loved one to the hospital, and when treatment can be done at home, to avoid the hassle and cost of hospitalisation. 

9. Takeaway Message

The lungs provide oxygen to the entire body. When the lungs are not well, the impact can be immediate and devastating. Thus, people with chronic lung disease need constant care and immediate intervention to preserve their respiratory capacity. This can be stressful on the patient and caregiver, but with proper support, you can still make the most of your golden years despite lung disease. 

In addition to having a regular family doctor and following doctor’s prescriptions and instructions, it is crucial to make sure you avoid triggers that can potentially cause acute episodes. This includes maintaining a clean home that is free from allergens, avoiding crowds and exposure to respiratory infections, keeping yourself hydrated and comfortably dressed, eating healthy and exercising regularly and safely.

You are also advised to keep your vaccination up to date such as Pneumococcal vaccination and annual flu vaccination.

We hope the article helps you care for chronic lung disease with more confidence and a peace of mind. As a leading provider of home care services with extensive experience caring for patients with lung diseases and other chronic conditions, we provide housecall doctors, caregivers and monitoring technology to enable 24/7 care for your loved ones. Chat with us below if you have any questions about managing chronic lung conditions at home. 


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