Chronic obstructive pulmonary disease (COPD) refers to a group of diseases that cause a blockage of airflow and affect breathing. COPD causes symptoms that worsen and improve in cycles.

According to the Centers for Disease Control and Prevention (CDC), COPD was the fourth leading cause of death in the United States in 2018. About 15.7 million people in the country have received a diagnosis of the disease.

People with COPD can experience exacerbations, or flare-ups, during which their symptoms worsen for a period. Flare-ups may be the result of certain avoidable triggers, and they can be less severe if a person begins to treat them during the early stages.

In this article, we explain what a COPD flare-up is, how long it may last, and when a person should seek help. We also look at how to manage and prevent COPD flare-ups.

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A flare-up is a worsening of COPD symptoms, typically due to triggers that include allergens or chest infections from a virus, such as flu. COPD flare-ups can be severe and are the most common reason for hospitalizations among people with the condition.

COPD symptoms can become worse rapidly, and a person may suddenly experience breathing difficulties, produce phlegm, and cough and wheeze. They may also experience heightened anxiety or have trouble sleeping.

A COPD flare-up may be more manageable if a person recognizes the early warning signs of an oncoming exacerbation. Early symptoms may include:

  • shortness of breath
  • a sore throat
  • cold- and flu-like symptoms
  • coughing more than usual
  • a change in mucus color, which may be brown, yellow, or green
  • producing more mucus, which may be stickier and thicker than usual
  • swollen ankles
  • feeling the need to sleep sitting rather than lying down
  • waking up at night coughing
  • waking up with a headache
  • fatigue

Ongoing symptoms of COPD that can suddenly worsen during a flare-up include:

  • wheezing or whistling when breathing
  • shortness of breath, particularly during physical activity
  • tightness in the chest
  • an ongoing cough that may produce mucus

A COPD flare-up can happen unexpectedly, so health experts recommend having a COPD action plan to follow. If a person feels warning signs of a flare-up, they should follow their COPD action plan. This may involve:

  • trying to remain calm and not panic, which could worsen breathing difficulties
  • taking an antibiotic or corticosteroid pill according to advice from a doctor — for example, the doctor may recommend taking corticosteroids or antibiotics at the first sign of an infection or cold
  • seeking medical attention if breathing remains shallow or is faster than usual and it is difficult to take deep breaths

A person should also seek emergency medical care for the following symptoms:

  • coughing up dark mucus
  • chest pain
  • difficulty breathing without sitting forward
  • confusion
  • extreme sleepiness
  • difficulty speaking
  • blue fingertips or lips
  • frequent headaches
  • high fever

Certain triggers may bring on a COPD flare-up. These can include:

  • changes in the weather
  • feeling anxious or stressed
  • lung infections, colds, and other illnesses
  • smoke and other pollutants
  • feeling run-down

A COPD flare-up can last for days or weeks, and a person may require corticosteroids, antibiotics, or treatment in hospital to recover.

In the later stages of COPD, a person may experience more regular flare-ups, which may lead to irreversible lung damage. It is important for a person to recognize the early signs of a flare-up and immediately seek treatment to avoid more severe symptoms.

At the first signs of a flare-up, a person can take steps to help manage the symptoms. These include:

  • remaining calm to keep breathing as evenly as possible
  • contacting a doctor
  • taking medication, which may include steroids and antibiotics, according to a doctor’s instructions
  • using oxygen by nasal prongs or mask if a doctor has prescribed it
  • trying breathing techniques, such as pursed lip breathing

There are steps a person can take to prevent COPD flare-ups. These include:

  • quitting smoking and avoiding secondhand smoke
  • having a medical grade pulse oximeter
  • using oxygen, if a doctor prescribes it
  • taking medications
  • starting a pulmonary rehabilitation program
  • attending regular health checkups
  • avoiding people who are sick with colds and other contagious viral infections
  • having all the recommended vaccinations, including the COVID-19 one
  • washing the hands frequently
  • avoiding pollutants, including smoke and dust, where possible
  • avoiding extremely cold temperatures
  • staying as active as possible
  • eating a nutritious, well-balanced diet

A COPD flare-up is a sudden worsening of COPD symptoms, which can include cold- or flu-like symptoms, a cough, and phlegm production.

COPD flare-ups can be severe and may cause lasting damage to the lungs. Therefore, it is important to seek medical attention following any persistent symptoms that do not respond to treatment. These symptoms may include coughing up dark mucus, chest pain, and the lips and fingertips turning blue.

A person can manage a COPD flare-up with breathing techniques, medication, and oxygen. They can help prevent flare-ups by taking medication, avoiding pollutants and other triggers, and starting a pulmonary rehabilitation program.