January 4, 2024/Lung

Preventing COPD Exacerbations and Flare-Ups

You can reduce your chances of a flare-up by quitting smoking, avoiding respiratory infections and following your doctor’s orders

female with hand on chest holding inhaler in other hand, with of breathlessness float in background

Breathe in. Breathe out. Most people don’t give it a second thought. But if you have chronic obstructive pulmonary disease (COPD), breathing difficulties are a part of life. And a flare-up of symptoms (known as exacerbation) might send you to the hospital.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“Preventing exacerbations is an essential part of treatment,” says pulmonologist Uddalak Majumdar, MD. “Every person with COPD should know the warning signs. Acting quickly can help limit the severity of an exacerbation and prevent further lung damage.”

Dr. Majumdar explains what you need to know about COPD exacerbations, including how to treat and prevent them.

What is a COPD exacerbation, or a flare-up?

COPD is a chronic lung disease that affects airflow in your lungs, making it hard to breathe. It’s a spectrum of disease that includes two common conditions — chronic bronchitis and emphysema. Symptoms of COPD include shortness of breath, wheezing and a long-standing cough, as well as less well-known signs like fatigue.

A COPD exacerbation is when symptoms worsen rapidly. A severe COPD exacerbation may require emergency medical care and can be life-threatening. Some people with COPD end up in the hospital several times a year due to exacerbations.

What are the signs of COPD exacerbation?

People with COPD have good days and bad days. But an exacerbation is more than a bad day, clarifies Dr. Majumdar. COPD exacerbation symptoms can vary. You may experience:

  • Increased shortness of breath, coughing, wheezing or mucus production.
  • Change in mucus color or thickness.
  • Excessive fatigue.
  • Lack of appetite.
  • More frequent use of your inhaler or nebulizer to control symptoms.

A severe COPD exacerbation can cause oxygen levels to drop — a life-threatening situation. Severe symptoms include:

  • Dizziness or confusion.
  • Severe shortness of breath.
  • Blue or gray lips or nails.
  • Chest pain.
  • Coughing up blood.
  • Fever, chills and shaking.

What’s the most common cause of COPD exacerbations?

COPD exacerbations occur when something triggers inflammation in narrowed airways. The most common causes of COPD exacerbations are respiratory infections, like a cold, flu or pneumonia.

A COVID-19 infection can also cause a COPD exacerbation. But studies of patient outcomes during the pandemic found this effect was less than expected.

“The inhaled medications we use to treat COPD seem to protect against COVID-19 and limit its severity, though we’re still learning about this fascinating aspect,” notes Dr. Majumdar.

Advertisement

Other triggers of COPD exacerbations include:

  • Air pollution.
  • Allergies or asthma.
  • Cigarette smoke.
  • Dust and chemicals in the air.
  • Extreme temperatures (hot or cold), humidity or weather changes.
  • Scented products (perfumes, air fresheners, cleaning supplies).

What’s the best treatment for a COPD exacerbation?

Recognizing a COPD exacerbation and getting treatment early may help you manage a flare-up and avoid the emergency room. If you’re living with COPD, take note of how you feel on a good day, so you can tell when your symptoms are getting worse.

COPD care includes developing a plan for what to do when symptoms flare. Dr. Majumdar uses the action and management plan from the American Lung Association. This document outlines self-management steps for color-coded zones based on how you feel:

  • Green zone. No symptoms. Continue your daily medications and other activities.
  • Yellow zone. More symptoms than usual. Follow your healthcare provider’s recommendations.
  • Red zone. Severe symptoms. Seek emergency medical care.

Proactive treatment to manage a COPD exacerbation targets the yellow zone. Your healthcare provider may give you corticosteroid or antibiotic medications to have on hand. You start taking them when symptoms flare. Other yellow zone actions may include:

  • Get extra rest.
  • Stay hydrated.
  • Stop smoking immediately.
  • Use a rescue inhaler.

If your symptoms don’t go away within a day or two or get worse, call your healthcare provider.

What you can do to prevent a COPD flare-up

A common myth about COPD is that it’s not treatable. With proper treatment, based on evidence and research, you can manage your symptoms and prevent exacerbations. Dr. Majumdar recommends these six steps:

1. Stop smoking

Smoking is the main cause of COPD. Continuing to smoke can make COPD worse and lead to exacerbations. If you’re ready to quit smoking, your healthcare provider can help.

2. Prevent infections

Respiratory infections are the top trigger for COPD exacerbations. Vaccines can protect you from certain respiratory infections, including the flu, pneumonia and COVID-19. Other infection prevention tips include:

3. Take your medications and inhalers as directed

Medications and inhalers are a core part of COPD treatment. Your healthcare provider will choose your medications based on your COPD stage, symptoms and previous exacerbations.

Advertisement

Using your inhalers as directed reduces your risk of COPD flare-ups. Inhalers can have issues when it comes to difficulty of use and costs. You can work with your provider and pharmacist to choose the appropriate inhaler. And your healthcare provider, respiratory therapists and/or pharmacists can help design a personalized medication plan for those with severe COPD.

4. Get active

Exercise can improve your strength and energy and ease COPD symptoms. Examples include stretching, aerobic exercise and resistance training. Before beginning a workout routine, talk to your doctor about what activities are right for you and how to get started.

Your provider may also recommend pulmonary rehabilitation to help get you moving. This program combines education and supervised exercise. Pulmonary rehabilitation staff provide a personalized plan and support to help you stick with it.

5. Manage other health conditions

Sleep apnea, heart disease, acid reflux and mental health disorders are all linked to COPD exacerbations. Talk to your healthcare provider about steps you can take to manage these related health conditions.

6. Eat a healthy diet

The food you eat fuels all your activities, including breathing. Eating a balanced diet can give you the energy and nutrients you need to be as healthy as possible.

Can you recover from a COPD exacerbation?

You can recover from a COPD exacerbation, but with frequent exacerbations, your lung function may decrease with time.

“Each flare-up can cause small but permanent lung damage,” explains Dr. Majumdar. “People who have frequent COPD flares often have poorer quality of life and health outcomes.”

Living with COPD can be a challenge. Your life may change, but it can still be full and active. Turn to your healthcare team for the information and tools you need to control the condition and prevent exacerbations.

Learn more about our editorial process.

Health Library
Chronic Obstructive Pulmonary Disease (COPD)

Related Articles

male sitting on couch using inhaler and holding chest
January 9, 2024/Lung
Understanding the Difference Between Asthma and COPD

Both conditions have similar symptoms, but different causes and treatments

close up of a person with oxygen supply in nose
December 19, 2023/Lung
Have COPD? Exercise Can Help Keep You Out of the Hospital

Get improved quality of life and breathe better

COPD in lungs as background with medications and person walking in foreground.
September 24, 2023/Lung
Get the Facts About COPD and Living With the Disease

Quitting smoking helps immediately, but this disease doesn’t only affect people who smoke

person using an inhaler
May 14, 2023/Infectious Disease
What Are the Long-Term Effects of RSV?

People with certain pre-existing medical conditions have increased risk factors

family roasting marshmallows around firepit
May 25, 2021/Lung
Fire Pits, Bonfires and Your Lungs: Safety Tips to Follow

Some tips to make your next fire safer

woman suffering from a persistent cough
April 15, 2020/Primary Care
What Does Your Cough Say About Your Illness?

Dry or wet, acute or chronic — it may point to a cause

Elderly man tired from COPD
June 17, 2019/Lung
COPD Fatigue Can Be Relentless, So Fight Back

How to get back your get-up-and-go

close up of arm with nicotine patch on it
January 3, 2024/Lung
How (and Why) to Quit Dipping for Good

Nicotine replacement products and relaxation techniques can help you ditch the dip

Trending Topics

Person in yellow tshirt and blue jeans relaxing on green couch in living room reading texts on their phone.
Here’s How Many Calories You Naturally Burn in a Day

Your metabolism may torch 1,300 to 2,000 calories daily with no activity

woman snacking on raisins and nuts
52 Foods High In Iron

Pump up your iron intake with foods like tuna, tofu and turkey

Ad