COPD flare-ups


COPD symptoms can worsen suddenly. You may find it hard to breathe. You may cough or wheeze more or produce more phlegm. You might also feel anxious and have trouble sleeping or doing your daily activities. This problem is called a COPD exacerbation, or COPD flare-up.

Alternate Names


Certain illnesses, colds, and lung infections from viruses or bacteria can lead to flare-ups. Other causes may include:

  • Being around smoke or other pollutants
  • Weather changes
  • Doing too much activity
  • Being run-down
  • Feeling stressed or anxious

You can often manage a flare-up right away with medicines and self-care. Work with your doctor on an action plan for COPD exacerbations so that you know what to do.

Get to know your usual symptoms, sleep patterns, and when you have good or bad days. This can help you learn the difference between your normal symptoms and signs of a COPD flare-up.

Warning signs of COPD flare-up

Signs of a COPD flare-up last 2 days or more and are more intense than your usual symptoms. The symptoms get worse and just don't go away. If you have a full-blown exacerbation, you may need to go to the hospital.

Common early signs include:

  • Trouble catching your breath
  • Noisy, wheezing, breathing sounds
  • Coughing, sometimes with more mucus than usual or a change in the color of your mucus

Other possible signs of flare-up include:

  • Not being able to take deep breaths
  • Difficulty sleeping
  • Morning headaches
  • Abdominal pain
  • Anxiety
  • Difficulty speaking
  • Swelling of the ankles or legs
  • Gray or pale skin
  • Blue or purple lips or nail tips

What to do at the first sign of a flare-up

  • Don't panic. You may be able to keep symptoms from getting worse.
  • Take medicines as directed for flare-ups. These may include quick-relief inhalers, steroids or antibiotics you take by mouth, or medicine through a nebulizer.
  • Take antibiotics as directed if your doctor prescribes them.
  • Use oxygen if prescribed.
  • Use pursed lip breathing to save energy, slow your breathing, and help you relax.
  • If your symptoms do not get better within 48 hours, or your symptoms keep getting worse, call your doctor or go to the hospital.

How to prevent COPD flare-ups

If you have COPD:

  • Stop smoking and avoid second-hand smoke. Avoiding smoke is the best way to slow down damage to your lungs. Ask your doctor about stop-smoking programs and other options, such as nicotine-replacement therapy.
  • Take your medicines as directed.
  • Ask your doctor about pulmonary rehabilitation. This program includes exercise, breathing, and nutrition tips.
  • See your doctor 1 to 2 times per year, or as directed for check-ups.

Avoid colds and the flu.

  • Stay away from people with colds.
  • Wash your hands often. Carry hand sanitizer for when you can't wash your hands.
  • Get all of your recommended vaccines, including a flu shot every year.
  • Avoid very cold air.
  • Keep air pollutants, such as fireplace smoke and dust, out of your home.

Live a healthy lifestyle.

  • Stay as active as possible. Try short walks and gentle weight-training. Talk with your doctor about ways to get exercise.
  • Take frequent breaks throughout the day. Rest between daily activities to save your energy and give your lungs time to recover.
  • Eat a healthy diet rich in lean proteins, fish, fruits, and vegetables. Eat several small meals a day.
  • Don't drink liquids with meals. That way you won't feel stuffed.

When to call your doctor

After following your COPD action plan, you should call your doctor if your breathing is still:

  • Getting harder
  • Faster than before
  • Shallow and you cannot get a deep breath

Also call your doctor if:

  • You need to lean forward when sitting in order to breathe easily
  • You are using muscles around your ribs to help you breathe
  • You are having headaches more often
  • You feel sleepy or confused
  • You have a fever
  • You are coughing up dark mucus
  • Your lips, fingertips, or the skin around your fingernails are blue
  • You have chest pain or discomfort


Chronic obstructive pulmonary disease. In: Ferri, FF. Ferri's Clinical Advisor 2014, 1st ed. Philadelphia, PA: Mosby Elsevier; 2013:section 1.

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Vancouver (WA): Global Initiative for Chronic Obstructive Lung Disease (GOLD); 2013.

Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155(3):179-191.

Version Info

  • Last reviewed on 2/8/2014
  • Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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