Chronic obstructive pulmonary disease symptoms can worsen suddenly. You may find it hard to breathe. You may cough or wheeze more or produce more phlegm. You might also feel anxious and have trouble sleeping or doing your daily activities. This problem is called a chronic obstructive pulmonary disease (COPD) exacerbation, or COPD flare-up.
Certain illnesses, colds, and lung infections from viruses or bacteria can lead to flare-ups. Other causes may include:
- Being around smoke or other pollutants
- Weather changes
- Doing too much activity
- Being run-down
- Feeling stressed or anxious
You can often manage a flare-up right away with medicines and self-care. Work with your doctor on an action plan for COPD exacerbations so that you know what to do.
Get to know your usual symptoms, sleep patterns, and when you have good or bad days. This can help you learn the difference between your normal symptoms and signs of a COPD flare-up.
Warning Signs of COPD Flare-up
Signs of a COPD flare-up last 2 days or more and are more intense than your usual symptoms. The symptoms get worse and just don't go away. If you have a full-blown exacerbation, you may need to go to the hospital.
Common early signs include:
- Trouble catching your breath
- Noisy, wheezing breathing sounds
- Coughing, sometimes with more mucus than usual or a change in the color of your mucus
Other possible signs of flare-up include:
- Not being able to take deep breaths
- Difficulty sleeping
- Morning headaches
- Abdominal pain
- Difficulty speaking
- Swelling of the ankles or legs
- Gray or pale skin
- Blue or purple lips or nail tips
- Trouble speaking in full sentences
What to do at the First Sign of a Flare-up
At the first sign of a flare-up:
- DO NOT panic. You may be able to keep symptoms from getting worse.
- Take medicines as directed for flare-ups. These may include quick-relief inhalers, steroids or antibiotics you take by mouth, anti-anxiety medicines, or medicine through a nebulizer.
- Take antibiotics as directed if your doctor prescribes them.
- Use oxygen if prescribed.
- Use pursed lip breathing to save energy, slow your breathing, and help you relax.
- If your symptoms do not get better within 48 hours, or your symptoms keep getting worse, call your doctor or go to the hospital.
How to Prevent COPD Flare-ups
If you have COPD:
- Stop smoking and avoid secondhand smoke. Avoiding smoke is the best way to slow down damage to your lungs. Ask your doctor about stop-smoking programs and other options, such as nicotine-replacement therapy.
- Take your medicines as directed.
- Ask your doctor about pulmonary rehabilitation. This program includes exercise, breathing, and nutrition tips.
- See your doctor 1 to 2 times per year for check-ups, or as directed.
- Use oxygen if your doctor recommends it.
Avoid colds and the flu, you should:
- Stay away from people with colds.
- Wash your hands often. Carry hand sanitizer for times when you cannot wash your hands.
- Get all of your recommended vaccines, including a flu shot every year.
- Avoid very cold air.
- Keep air pollutants, such as fireplace smoke and dust, out of your home.
Live a healthy lifestyle:
- Stay as active as possible. Try short walks and light weight-training. Talk with your doctor about ways to get exercise.
- Take frequent breaks throughout the day. Rest between daily activities to save your energy and give your lungs time to recover.
- Eat a healthy diet rich in lean proteins, fish, fruits, and vegetables. Eat several small meals a day.
- DO NOT drink liquids with meals. This will keep you from feeling too full. But, be sure to drink liquids at other times to keep from getting dehydrated.
When to Call the Doctor
After following your COPD action plan, call your doctor if your breathing is still:
- Getting harder
- Faster than before
- Shallow and you cannot get a deep breath
Also call your doctor if:
- You need to lean forward when sitting in order to breathe easily
- You are using muscles around your ribs to help you breathe
- You are having headaches more often
- You feel sleepy or confused
- You have a fever
- You are coughing up dark mucus
- Your lips, fingertips, or the skin around your fingernails is blue
- You have chest pain or discomfort
- You cannot speak in full sentences
COPD exacerbation; Chronic obstructive pulmonary disease exacerbation; Emphysema exacerbation; Chronic bronchitis exacerbation
Han MK, Lazarus SC. COPD. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 44.
Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155(3):179-91. PMID: 21810710 www.ncbi.nlm.nih.gov/pubmed/21810710.
Vestbo J, Hurd SS, Agusti AG, et al. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Vancouver, WA: GOLD; 2013. PMID: 22878278 www.ncbi.nlm.nih.gov/pubmed/22878278. Accessed November 1, 2015.
Update Date 11/19/2015
Updated by: Denis Hadjiliadis, MD, MHS, Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.