Preventing COPD Exacerbations and Flare-Ups

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.

“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.

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:

• Avoid people who are sick.
• Wash your hands frequently.
• Wear a mask in public.

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.

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.