COPD flare ups

Overview

A COPD flare-up (also called an exacerbation) is when your COPD symptoms suddenly get worse and stay worse for a few days. It means extra inflammation in your airways and lungs. You may feel much more breathless, have more coughing, or bring up more mucus than usual.

Yes. COPD flare-ups are very common. On average, people with COPD may have one or more a year, though this varies widely.

COPD itself affects mostly people over 40, often long-term smokers or ex-smokers. Flare-ups can happen to anyone with COPD, but they are more frequent in people with moderate or severe COPD, or people who continue to smoke.

Symptoms

Common symptoms

• More breathlessness than usual, even at rest
• A cough that is worse than normal
• More mucus (phlegm) than usual, or mucus that has changed color or thickness
• Wheezing (a whistling sound when you breathe)
• Feeling very tired or weak
• Sleep problems because of breathing trouble

Symptoms in children

• COPD does not usually affect children. Children with breathing problems may have other conditions like asthma. If a child has any breathing trouble, seek medical advice quickly.

Symptoms in older adults

• Older adults may not notice a fever or chest symptoms clearly. They might just feel unusually confused, sleepy, or weak.
• A flare-up can greatly increase the risk of falls and loss of independence, so it is important to treat it early.

Causes

Main causes

• Infections like colds, flu, or chest infections
• Breathing in irritants such as cigarette smoke, air pollution, dust, or strong fumes
• Cold weather or sudden changes in temperature
• Being around people who smoke or having poor indoor air quality

Risk factors

• Have been diagnosed with severe or very severe COPD
• Already have had a flare-up in the last year
• Continue to smoke or are exposed to secondhand smoke
• Use an oxygen concentrator incorrectly or do not take your maintenance medicines as prescribed
• Have other health conditions like heart failure, diabetes, or chronic kidney disease

When to see a doctor

See a doctor urgently if:

• Call your local emergency number (e.g., 911, 999, 112) if you have any of the emergency symptoms listed above.
• Go to the nearest emergency department if you are struggling to breathe, feel very drowsy, or have blue lips.

Book a routine appointment if:

• Contact your healthcare team if your symptoms are worse for more than 2 days or you need to use your rescue inhaler much more often.
• Make an urgent same-day appointment if you have new-colored mucus, fever, or feel generally unwell.

Diagnosis

Your doctor will listen to your chest, ask how you have been feeling, check your oxygen levels with a small sensor on your finger (pulse oximeter), and may request a chest X-ray or blood tests to look for infection.

Tests that may be done

• Pulse oximetry — a clip on your finger to measure oxygen in your blood
• Chest X-ray — to check for lung infection or other problems
• Blood tests — to look for inflammation and check your kidney function
• Sputum (mucus) sample — to see if bacteria are causing your symptoms

What to expect at your appointment

At the hospital or clinic, a doctor or nurse will assess how severe your flare-up is. You may be given extra oxygen through nasal tubes and be asked to inhale medications that help open your airways. If you are seriously ill, you may need to stay in the hospital for a few days.

Treatment

Treatment for a flare-up focuses on helping you breathe more easily, treating the cause (like an infection), and preventing future flare-ups. You will likely need a short course of extra medication, more rest, and close follow-up with your healthcare team.

Self-care at home

• Take your prescribed 'rescue' inhaler as soon as you notice symptoms
• Do pursed-lip breathing and slow, relaxed breaths to ease breathlessness
• Rest but keep gently moving around the house if you can
• Drink plenty of fluids to keep mucus thinned
• Try to sleep upright or propped up with pillows to help your breathing
• Use a cool-mist humidifier or sit in a steamy bathroom if the air is dry

Medical treatments

Your doctor may prescribe medications to open your airways (bronchodilators) that you inhale through a nebulizer or inhaler. You may also get anti-inflammatory medicines (like oral steroids) for a short time. If a bacterial infection is suspected, you might be given antibiotics. Always take exactly as prescribed, even if you feel better. Oxygen therapy may also be used if your oxygen levels are low.

When is surgery considered?

Surgery is not part of routine flare-up treatment. For a small number of people with very severe COPD, procedures such as lung volume reduction or a lung transplant may be options after careful evaluation. Your specialist can discuss this if it is ever relevant for you.

Living with this condition

Managing COPD is a long-term plan. Learn to recognize the early signs of a flare-up so you can act quickly. Keep a list of your medications and emergency contacts. Pacing your activities and using energy-saving techniques can help you stay independent.

Lifestyle tips

• If you smoke, getting help to quit is the most powerful thing you can do
• Avoid breathing in smoke, dust, chemicals, or air pollution
• Exercise regularly — a pulmonary rehabilitation program can teach you safe exercises
• Get a flu vaccination every year and ask about the pneumonia and COVID-19 vaccines
• Wash your hands often to reduce the risk of infection
• Stay up to date with your maintenance inhaler routine, even when you feel well

Diet and exercise

A healthy, balanced diet helps keep your immune system strong. If you are losing weight, eat little and often. If you are overweight, losing even a little weight can make breathing easier. Gentle exercise — like walking, cycling, or chair exercises — can improve your stamina. Talk to your doctor or a physiotherapist about what is safe for you.

Mental health and emotional wellbeing

Living with COPD and the fear of flare-ups can cause anxiety and depression. Feeling anxious can also make you feel more breathless. It is important to talk about how you feel with your healthcare team. They can offer support, relaxation techniques, or counselling.

Prevention

You cannot always prevent a flare-up, but you can lower the risk. The main things are to stop smoking, avoid triggers, get vaccinated, and take your regular maintenance medicines exactly as prescribed.

Vaccines

Everyone with COPD should get an annual flu vaccine and a COVID-19 vaccine. Ask your doctor about the pneumonia vaccine and whether a new booster dose is advised for you. These vaccines help prevent infections that often trigger flare-ups.

Screening programmes

There is no routine screening test for COPD in everyone. If you have symptoms or a history of smoking, your doctor can arrange a breathing test called spirometry to check your lungs.

Complications

If left untreated

• Breathing failure, when your lungs cannot get enough oxygen into your blood
• The need for intensive care and a breathing tube
• A higher risk of lung infection (pneumonia)
• Damage to the heart, including irregular heartbeats or heart failure
• Reduced quality of life and greater difficulty with everyday activities

Long-term outlook

Most people recover from a flare-up with prompt care and time. Your lung function may return to near what it was before. Repeated flare-ups can cause long-term damage, but working with your healthcare team and following a clear action plan can help you stay well and active for as long as possible.

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