A COPD exacerbation—often called a flare-up—is a sudden worsening of symptoms in people living with Chronic Obstructive Pulmonary Disease. These episodes can develop quickly, become life-threatening if ignored, and are one of the leading causes of hospitalization among COPD patients.

Understanding the early warning signs—and knowing how to respond—can dramatically reduce complications, slow disease progression, and even save lives.

What Is a COPD Exacerbation?

A COPD exacerbation is defined as an acute change in baseline respiratory symptoms that goes beyond normal day-to-day variation and requires additional treatment. Flare-ups may last from a few days to several weeks and often recur if triggers are not controlled.

Common triggers include:

• Respiratory infections (viral or bacterial)

• Air pollution or smoke exposure

• Sudden weather changes

• Poor medication adherence

• Stress or lack of sleep

Why COPD Flare-Ups Are So Dangerous

Each exacerbation:

• Accelerates lung function decline

• Increases the risk of future flare-ups

• Weakens the immune system

• Raises the likelihood of hospitalization and mortality

Repeated flare-ups can permanently worsen breathing capacity—even if symptoms later improve.

Early Warning Signs You Should Never Ignore

Recognizing symptoms early allows for faster intervention and better outcomes.

Respiratory Changes

• Increased shortness of breath (especially at rest)

• Faster or shallow breathing

• Wheezing or chest tightness

• Reduced ability to walk or talk without gasping

Changes in Cough & Mucus

• More frequent or severe coughing

• Increased mucus production

• Thickened sputum

• Change in mucus color (yellow, green, or bloody)

Systemic Symptoms

• Extreme fatigue or weakness

• Confusion or difficulty concentrating

• Fever or chills (often signal infection)

• Swollen ankles or legs (fluid retention)

Severe Symptoms That Require Immediate Medical Care

Seek urgent help if you experience:

• Blue or gray lips/fingertips (low oxygen)

• Severe breathlessness not relieved by inhalers

• Chest pain

• Drowsiness or loss of consciousness

These may indicate respiratory failure and require emergency treatment.

What Causes COPD Exacerbations?

Infections

Respiratory infections account for up to 70% of flare-ups. Viruses weaken lung defenses, allowing bacteria to multiply.

Environmental Exposure

• Cigarette smoke (active or passive)

• Air pollution

• Chemical fumes

• Dust and allergens

Medication Issues

• Skipping maintenance inhalers

• Incorrect inhaler technique

• Running out of prescriptions

How COPD Exacerbations Are Treated

Treatment depends on severity and cause:

Medications

• Short-acting bronchodilators (rescue inhalers)

• Oral or inhaled corticosteroids

• Antibiotics (if bacterial infection suspected)

Oxygen Therapy

Used when blood oxygen levels drop dangerously low.

Hospital Care

Severe cases may require:

• IV medications

• Non-invasive ventilation

• Intensive monitoring

Preventing Future COPD Flare-Ups

Daily Prevention Strategies

• Take medications exactly as prescribed

• Avoid smoke and polluted environments

• Wash hands frequently

• Get annual flu and pneumonia vaccines

Pulmonary Rehabilitation

Exercise training and breathing techniques improve lung efficiency and reduce flare-up frequency.

Have an Action Plan

A written COPD action plan helps patients recognize early symptoms and act quickly—often preventing hospitalization.

When to Contact Your Doctor

Call your healthcare provider if:

• Symptoms worsen for more than 24–48 hours

• Rescue inhalers stop working

• You notice changes in mucus or fever

Early treatment is the most effective way to stop a mild flare-up from becoming severe.

Living Well With COPD

Although COPD is a chronic condition, many people live active, fulfilling lives by recognizing flare-ups early, avoiding triggers, and staying consistent with treatment.

Education is one of the strongest tools you have.