Chronic obstructive pulmonary disease (COPD) is a progressive condition that affects the airways. With worsening COPD, symptoms — such as chest tightness, wheezing, shortness of breath, and a cough — become worse

COPD can start with minimal symptoms. However, as the disease progresses, the symptoms can worsen and become more obvious.

This article examines the signs and symptoms of worsening COPD. It also looks at management methods, how COPD progresses, and more.

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The National Heart, Lung, and Blood Institute (NHLBI) notes that COPD may not cause noticeable symptoms at first. However, as the disease progresses, a person will likely experience worsening symptoms.

Some common symptoms of COPD that may worsen include:

  • a persistent cough with changes in mucus color or thickness
  • wheezing, squeaking, or whistling while breathing
  • tightness in the chest
  • shortness of breath that gets worse with physical activity

In addition, a person may become more susceptible to lung infections, including colds, flu, and other respiratory illnesses.

A person may also experience exacerbations or flares. These are periods during which a person’s symptoms worsen suddenly, within hours or days.

A person may notice a worsening cough or shortness of breath. Other signs of an exacerbation include:

If a person notices that their symptoms are progressively getting worse, they should contact a doctor.

There is no cure for COPD. However, treatments are available to help relieve the symptoms. The treatment options include:

  • Bronchodilators: A person can inhale bronchodilators, which open the airways. These medications can be short-acting or long-acting. They include beta2-agonists, such as albuterol (Ventolin) or levalbuterol (Xopenex), and anticholinergics, such as tiotropium (Spiriva) or ipratropium (Atrovent). There are two forms of bronchodilators: an inhaled form that people can take using meter dose inhalers and a liquid solution that people can take using a nebulizer.
  • Anti-inflammatory drugs: A person can take steroids and corticosteroids in the form of an inhaler or a pill.
  • Antibiotics: These can help treat bacterial infections that can worsen COPD symptoms. They can also help treat acute or chronic infections in those who experience recurrent exacerbations.

A doctor may prescribe combined medications, which include a corticosteroid, a beta-agonist, and an anticholinergic.

People should also ensure that they get vaccinations for influenza and pneumonia.

Other management options include supplemental oxygen and pulmonary rehabilitation.

For those with both COPD and asthma, a doctor may prescribe injectable biologic therapy.

COPD exacerbation management

A person who experiences a COPD exacerbation or flare will likely need to seek medical treatment. The extent of the treatment will depend on the severity of the attack.

The American Lung Association recommends having an action plan in place. A person can create this action plan with a doctor, who may advise them to take the following actions:

Green• able to perform typical levels of exercise and activity
• typical amounts of coughing and phlegm
• sleeping well
• having a good appetite
• take the daily medications
• continue regular exercise
• eat as normal
• use prescribed oxygen
Yellow• feeling more breathless
• having less energy
• producing more or thicker phlegm
• requiring the quick-relief inhaler more often
• swollen ankles
• coughing more
• the feeling of a chest cold
• poor sleep
• having a poor appetite
• no response to usual medicine
• take the daily medications
• use the quick-relief inhaler as the doctor suggested
• take an oral corticosteroid as the doctor suggested
• use prescribed oxygen
• rest
• perform pursed lip breathing
Red• severe shortness of breath
• unable to perform daily activities
• unable to sleep
• fever
• confusion
• drowsiness
• coughing up blood
• call 911

Learn more about the treatment options for COPD exacerbations.

Several factors can affect the duration of an exacerbation.

According to an older study, there are two types of exacerbations — sudden onset and gradual onset. In sudden onset flares, the symptoms often peak within hours. In cases of gradual onset, the average time for symptom development is about 4 days.

A person’s ability to recognize and respond to an exacerbation may help shorten the attack. The sooner a person starts treatment, the faster they should be able to stop the exacerbation from getting worse.

COPD is a progressive condition that gets worse over time. Two factors that can increase the rate of COPD progression are COPD exacerbations and smoking.

Research indicates that exacerbations can lead to decreased lung function, and the NHLBI notes that damage will occur faster if a person who currently smokes continues to do so.

Learn about the progression of COPD.

A person may experience worsening symptoms or exacerbations when they have exposure to triggers. Although everyone responds to stimuli differently, some triggers include:

  • smoking or exposure to secondhand smoke
  • exposure to pollutants in the air
  • illnesses, such as a cold or influenza
  • allergens

It is not always possible to stop all exacerbations from occurring. It is also not possible to cure COPD.

However, proper treatment can help by:

  • slowing the progression
  • preventing exacerbations from occurring
  • minimizing symptoms to improve quality of life

Some potential ways to help prevent exacerbations from occurring include:

  • stopping or quitting smoking
  • avoiding people who are sick with the flu or a cold
  • getting the flu and COVID vaccines
  • practicing good hygiene, such as washing the hands regularly and thoroughly, to avoid sickness

A person should speak with a doctor if their symptoms are getting worse. A doctor may be able to recommend additional treatments or lifestyle changes that may help slow the progression of the condition.

A person should go to the hospital if their usual treatments are no longer helping control their symptoms and they have trouble breathing even when at rest.

COPD is a progressive disease that worsens over time. As the disease progresses, a person may experience worsening symptoms, known as exacerbations.

Exacerbations can be life threatening and cause damage to the lungs. A person should take steps at home to treat the symptoms, but if the symptoms keep getting worse, they should go to the hospital for treatment.