What is a COPD exacerbation?

Middle aged woman sitting at table coughing into elbow

When your COPD symptoms suddenly worsen, you may think you’re just having a really bad breathing day. This might, however, mean you’re having an exacerbation. A COPD exacerbation, also known as a COPD flare-up or episode, occurs when your COPD symptoms get worse than usual and may continue to get worse without extra treatment. The average annual rate of exacerbations in COPD patients is between 0.85 and 1.30 episodes. Exacerbations can be very serious. While everyone experiences exacerbations differently, there are a number of possible warning signs. We look at the key characteristics of a COPD exacerbation and what to do if you’re experiencing one.

COPD exacerbation warning signs

Sometimes it’s easy to confuse COPD exacerbation warning signs with other conditions you may be experiencing, like severe allergies or a very bad cold. However, the signs of a COPD exacerbation typically go beyond your day-to-day COPD symptoms. 

Warning signs that an exacerbation is beginning can be different for each person. Most of the time, only you will know best when your breathing problems feel abnormal. Friends and family can help you notice and not ignore the early signs and symptoms so that you can get help before you need emergency aid. Having all of these listed on your COPD action plan can make it easier to know when to call your doctor or get emergency help. An action plan is a written agreement that spells out how to handle your symptoms as your condition changes. It should be tailored specifically to your experience with COPD, covering a full range of events, from when you feel good to if you need emergency medical care.

The most common early warning signs and symptoms of an oncoming exacerbation are:

  • More coughing, wheezing, or shortness of breath with the same or less activity
  • Changes in the color, thickness, or amount of mucus
  • Increased use of rescue or quick relief inhaler or nebulizer medicines.
  • Fatigue that lasts for more than one day
  • Swelling of the legs or ankles
  • More trouble sleeping than usual
  • Feeling the need to increase the oxygen in your blood
    • Morning headaches, dizzy spells, and restlessness.
    • A need to increase your oxygen, if you are on oxygen.
    • Rapid breathing.
    • Rapid heart rate.
  • Low-grade fever that doesn’t go away

If you experience any of the above symptoms, be sure to call your doctor as soon as possible.

If you experience any of these very dangerous warning signs, call 911 immediately:

  • Severe shortness of breath or chest pain
  • Blue color in lips or fingers
  • Confusion, disorientation, or slurring of speech

What causes exacerbations?

Exacerbations are almost always caused by a viral or bacterial lung infection, but they may also be triggered by things or situations that make it difficult for you to breathe, such as smoking or being exposed to air pollution. Other causes of exacerbations may include sinus infections, an asthma attack, or an allergic reaction (not usually food allergies).

Exacerbations can last for days or even weeks, and may require antibiotics, oral corticosteroids, and in severe cases, hospitalization, for you to get back equilibrium. Exacerbations tend to increase in frequency as your lung function declines toward the later stages of COPD. Each time they occur, they may leave behind permanent, irreversible lung damage, so it’s important to learn how you can reduce your risk.

Reduce the risk of experiencing a COPD exacerbation

You cannot prevent all exacerbations, but you can work to reduce how often you have them. These tips from the COPD Foundation can help you work on reducing the frequency and severity of exacerbations: 

  • Handwashing is key to stopping the spread of bacterial and viral infections. You can follow best practices for handwashing here. 
  • Avoid close contact with people who have colds or were diagnosed with respiratory infections like the flu or COVID-19.
  • Get a flu shot each year.
  • Always take your daily controller/maintenance medicines as you and your doctor have talked about.
  • Make sure you know how to use your inhalers and nebulizers. Ask the doctor, nurse, or pharmacist to watch you use your inhalers.
  • Work out a COPD action plan with your health care professional so you know the early signs and what to do if a flare-up starts.
  • Don’t wait to see if the exacerbation is going to “get bad.” Call early and get the help you need.
  • Do not take cough syrups that include codeine or any type of cough suppressant.
  • Do not smoke and don’t let others smoke around you.
  • Do not wait more than 24 hours to call your health care provider if your symptoms continue.

It’s absolutely critical to be prepared ahead of time, which can help alleviate any panic that might strike in the wake of an exacerbation. 

New studies are testing the safety and efficacy of investigational treatments for COPD, especially for people who have recently had multiple exacerbations. Learn more about participating in these clinical trials below.