Chronic obstructive pulmonary disease, or COPD, is a group of diseases that cause airflow blockage and extreme breathing problems to the point of breathlessness. Exacerbations are attacks of restricted breathing that can cause lung damage.

This can lead to life threatening complications that can make the disease progress faster.

COPD mainly includes emphysema and chronic bronchitis. There is no cure for COPD, and a person may experience extreme breathlessness at all times once it progresses to a severe stage.

Some people confuse their symptoms with other conditions and do not seek diagnosis until the disease is advanced. COPD can be life threatening if it is left untreated.

In this article, we explain the potential triggers of a COPD exacerbation, how to recognize when one is happening, and how to treat them.

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A person with an exacerbation of COPD may experience more wheezing than usual.

Exacerbations can develop quickly. Sometimes, they do so with little warning.

Typical tests, such as chest X-rays and blood tests, are often unable to detect the severity of an exacerbation. It is therefore important to understand the early signs. People with COPD should be aware of even slight changes in their symptoms.

By understanding the signs and symptoms, they can seek immediate medical attention to limit complications.

People should note the symptoms of exacerbations in relation to their usual condition. These include:

  • more wheezing than normal
  • a persistent cough
  • extreme shortness of breath that is worse than usual
  • shallow or rapid breathing
  • a noticeable increase in mucus production
  • changes to the color of mucus, which may be yellow, green, tan, or bloody
  • a fever
  • confusion or sleepiness
  • swelling in the feet or ankles

Read more about how COPD develops in the lungs.

In most cases, a COPD exacerbation has direct links to an infection in the lungs or the body. The infection is typically the result of a virus, but bacteria or other organisms can also be responsible.

The infection causes inflammation in the lungs. This leads to narrowing of the airways. Blockage occurs due to swelling and mucus production.

If a person with COPD continues to smoke tobacco, this may also increase the risk of an exacerbation.

Exacerbations might also occur as the result of a severe allergy or inhaling irritating substances from the environment, such as heavy air pollution. Other possible triggers include:

  • weather changes
  • excessive physical exertion
  • not getting enough sleep or being run down
  • stress or anxiety

Sometimes, a person or their doctor does not know the exact cause of the exacerbation.

The frequency of COPD exacerbations may vary depending on the individual. A variety of conditions contribute to exacerbations.

A 2014 report in PLOS One showed that the following people were more likely to have one or more exacerbations the next year:

  • older adults
  • females
  • people with reduced lung function
  • those who had a history of exacerbations in the previous year
  • individuals with a frequent cough that produces phlegm

Exacerbations can be severe and life threatening. At the first sign of symptoms, a person should seek immediate medical care.

Depending on the severity and cause, people experiencing a COPD exacerbation will often need to stay in the hospital. Sometimes, a person can manage exacerbations at home, depending on their overall health.

Treatments include:

oxygen therapy, which supplements oxygen in people with reduced oxygen levels

  • glucocorticosteroids, which reduce inflammation
  • antibiotics, which help a person fight bacterial lung infections
  • antiviral medication, which can help an individual treat flu
  • bronchodilators, which can help expand the airways
  • respiratory stimulants,
  • respiratory or ventilator support, which people use when they are too tired or weak to breathe adequately on their own.

People who experience recurrent exacerbations have a faster decline in lung function and an increased risk of death. This especially applies to people who require hospitalization. Those who experience a mild exacerbation will receive a prescription for medications to take at home.

Exacerbations need immediate treatment because it can take someone a long time to recover. When an exacerbation occurs due to a respiratory infection, mucus production may increase, leading to inflammation and loss of lung function.

People with a viral infection have an increased risk of developing a secondary bacterial infection.

Outside of flu treatment, there are no medications that can slow a viral lung infection.

Here, learn all about inhaled medication for COPD.

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A person may prevent COPD exacerbations by getting enough sleep.

It is not possible to prevent all COPD exacerbations, especially in the advanced stages of the disease. However, people can take certain steps to limit their occurrence and severity.

Quitting smoking is the most important lifestyle change any person with lung disease can make. This will help to improve their medical condition, reduce the recurrence of exacerbations, and enhance their quality of life.

Enrolling in a smoking cessation program can help a person who finds it difficult to quit without assistance.

Other steps include:

  • Maintaining treatment: People should attend all regularly scheduled appointments with doctors and keep up with medication regimens. A doctor can monitor progress and prescribe any other necessary medications. This can help keep symptoms in check and reduce the risk of exacerbations.
  • Receiving vaccinations: Influenza is dangerous for people with COPD and can cause life threatening exacerbations and complications, so people with COPD must get the flu vaccination. Doctors also recommend having pneumonia and whooping cough jabs. It might also help to stay away from crowded places during flu and cold season.
  • Keeping on top of hygiene: People with COPD should wash their hands often with soap and water to minimize the transfer of viruses and bacteria. Some people with COPD choose to carry a bottle of hand sanitizer.
  • Getting plenty of rest: Exacerbations are more likely to occur if a person with COPD is not getting enough sleep or rest.
  • Living a healthful lifestyle: Exercising, participating in pulmonary rehabilitation, and following a balanced diet can help limit the risk of exacerbation. Being overweight or underweight may contribute to health problems in people with COPD.
  • Avoiding pollutants and irritants: Keeping away from potential triggers can reduce the risk of life threatening exacerbations.

Exacerbations can cause serious health problems for people with COPD.

Understanding the risk factors and recognizing the symptoms may mean that a person can receive timely treatment before complications occur.

People in the later stages of COPD or with severe symptoms may need to go to the hospital when they experience an exacerbation. However, those with less severe symptoms may be able to manage them at home using prescribed medications.

People with COPD and their caregivers should work with their doctor and medical team to make sure that everyone understands the appropriate actions when exacerbations occur.

The key to preventing or lowering the risk of exacerbations is understanding the risk factors, knowing the signs and symptoms, and having an action plan in place.


Will exacerbation ever resolve without treatment?


COPD exacerbations are associated with symptoms of worsening shortness of breath, cough and sputum production, and worsening of airway obstruction.

Studies have shown that people with COPD can have worsening symptoms from baseline that resolve by themselves about half the time. However, this typically involves worsening of one symptom for about 1–2 days. A person should seek medical treatment if they cross the threshold to an exacerbation, which some studies define as worsening of multiple symptoms for 2 or more days.

If your symptoms are worse than baseline for more than a day, or if you have severe symptoms for any duration, you should seek medical care.

Adithya Cattamanchi, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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