When should someone with flu symptoms seek emergency care?

Question

Hi doctor,

My father is 63 and caught the flu four days ago. Initially, we thought it was just a normal seasonal flu, but by day two, he developed a high fever of 103.5 degrees Fahrenheit, severe chills, and his breathing now seems a bit labored.

He received his flu shot this year, so we did not panic at first. He has mild COPD and takes tiotropium daily, and we are now wondering if that is making things worse. His oxygen level at home reads 93%, which seems low to us.

I do not understand why the flu seems to hit him so much harder than it does the rest of the family, who are also sick but recovering quickly.

Why does the flu progress to be more dangerous in someone his age compared to younger adults?
At what point should we take him to the emergency room?
Should he be on antivirals like Oseltamivir right now?

I really appreciate any help you can provide.

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concerns.

At his age, the flu can act more aggressively compared to younger individuals, particularly in someone with COPD (chronic obstructive pulmonary disease). Even mild COPD means that the lungs lack the same reserve as healthy lungs, making viral infections more problematic. This is why elderly patients may become significantly sicker, even when other family members recover quickly from the same infection.

The flu vaccine remains beneficial and likely reduces the risk of severe complications, hospitalization, or ICU (intensive care unit) care. However, it cannot always completely prevent infection. I see this quite often during flu season in older patients with lung disease.

Tiotropium is not worsening the condition; he should continue using his regular inhaler. Stopping maintenance inhalers during an infection can actually exacerbate breathing symptoms.

A fever of 103.5 degrees Fahrenheit, coupled with chills and labored breathing, should not be ignored in a 63-year-old COPD patient. An oxygen saturation of 93% is slightly low, especially if his usual saturation is higher. More importantly, if his breathing effort is increasing, he requires medical evaluation because influenza in elderly patients can sometimes lead to pneumonia or trigger a COPD exacerbation. You should take him for an urgent evaluation.

Regarding Oseltamivir, he falls into a high-risk group where antiviral medications are typically considered. Although they are most effective when started early, many doctors prescribe them later for elderly or COPD patients if symptoms are significant or worsening. He may also need a chest examination and possibly a chest X-ray to rule out associated pneumonia.

I hope this information is helpful to you. Please follow up with more details.

Thank you.