COPD flare-ups

Also known as COPD exacerbations

A flare-up is when your symptoms suddenly get worse, such as shortness of breath or cough. You should act quickly and follow your treatment plan as soon as you realise your symptoms are getting worse.

Key points

  1. A flare-up or exacerbation might be triggered by an infection or there may be no apparent reason. 
  2. Signs of a flare-up include coughing or wheezing more, more phlegm or mucus than usual, change in the colour and consistency of your phlegm, more shortness of breath than usual and feeling more tired. 
  3. The best way to manage a COPD flare-up is to have a COPD action plan and use your medicines as described in the plan.
  4. A COPD action plan is a written document that provides you with instructions and information on how to manage your COPD on a daily basis and also how to recognise and cope with worsening symptoms (exacerbations).
  5. You can develop your COPD action plan with your healthcare provider and fit the plan to suit the severity of your COPD and your preferences.

See your doctor or go to the nearest emergency department immediately if you or someone you care for experience the following:

  • very short of breath when sitting or lying down
  • feeling unusually restless, confused or drowsy
  • chest pain
  • swollen ankles
  • slurred speech
  • your lips or your skin turns blue
  • your symptoms get worse suddenly despite following your COPD action plan.

What is a COPD flare-up?

A COPD flare-up is when your COPD symptoms become worse suddenly and particularly severe. A flare-up might be triggered by an infection or there may be no apparent reason. A flare-up is also called an exacerbation.

Each COPD flare-up does long-term damage to your lungs and is a common cause of admission to hospital. It's important to be prepared – to recognise the symptoms of a flare-up and know what to do. Taking action early can prevent worsening symptoms and hospital admission. Read more about COPD.

What are the signs of a flare-up?

Signs of a flare-up

  • Cough or wheeze more
  • Harder to breathe than normal – being less able to do any physical exercise or do your usual daily activities.
  • More phlegm or mucous
  • Change in the colour and consistency of your phlegm
  • Feeling tired – have less energy
  • Eating less

What can I do if I have a flare-up?

The best way to manage a COPD flare-up is to have a COPD action plan and use your medicines as described in the plan.

A COPD action plan is a written document that provides you with instructions and information on how to manage your COPD on a daily basis and also how to recognise and cope with worsening symptoms (exacerbations). You can develop your COPD action plan with your healthcare provider and fit the plan to suit the severity of your COPD and your preferences. At each visit with your healthcare provider you can review the plan and make adjustments as needed.

Here are two examples of COPD action plans, choose the one that suits you.

COPD action plan

Blue card regional COPD action plan

COPD action plan The Asthma and Respiratory Foundation, NZ, 2020

Blue card regional COPD action plan District Health Boards, NZ, 2019

Medicines

Your action plan will include instructions on changes to make to your medicines, such as the following:

  • Reliever medicine: Increase the dose of your reliever medicine. This quickly opens the airways making it easier to breathe. Relievers usually start working within minutes and their effect lasts for a few hours. Read more about quick relievers.

 
Image credits: Relievers Asthma Canada

  • Spacer: If you are using a puffer or metered-dose inhaler (puffer), use a spacer with it to get the most benefit from your inhaler. Spacers are large empty plastic containers that you attach to your inhaler. By using a spacer with your inhaler, more of the medicine gets into your lungs. They are free from your doctor. Read more about spacers  
  • Steroid tablets: Your doctor may prescribe a course of steroid tablets (prednisolone) to take daily for a few days (usually 5 days). They work best if taken as soon as the flare-up starts, so your doctor may give you some tablets to keep at home in case you have a flare-up.
  • Antibiotics: Your doctor may prescribe a course of antibiotics if an infection has triggered your flare-up.

You can also learn these breathlessness strategies when you are feeling breathless along with making changes to your current medicines. 

However, having an action plan does not replace your doctor. It enables you to start treatment early. You should still arrange to see your doctor as soon as possible. Tell your doctor or nurse if your symptoms don’t improve after starting the medicines you keep at home.

Sometimes, you may require hospital admissions for severe flare-ups or exacerbations. The table below shows some of the symptoms or signs that may require you to see your doctor or go to the hospital immediately.

See your doctor or go to the nearest emergency department immediately if you or someone you care for experience the following:

  • very short of breath when sitting or lying down
  • feeling unusually restless, confused or drowsy
  • chest pain
  • swollen ankles
  • slurred speech
  • your lips or your skin turns blue
  • your symptoms get worse suddenly despite following your COPD action plan.

How is a flare-up managed in the hospital?

In the hospital, treatment for a flare-up may include:

  • using nebulisers to deliver medicines if your symptoms don't improve after using inhalers 
  • oxygen if your oxygen level is low
  • a short course of steroid tablets
  • antibiotics if there is an infection going on 
  • non-invasive ventilation. 

Non-invasive ventilation (NIV)

Sometimes, if your COPD flare-up or exacerbation is very severe, you may need a form of breathing support, this is known as non-invasive ventilation (NIV). As its name suggests, NIV is a type of breathing support that is non-invasive. Instead of putting a breathing tube into your airway, it only uses a face mask to support your breathing. This helps remove the excess carbon dioxide in your blood, increase your oxygen levels and reduce the need for being admitted to an intensive care unit. 

Before discharge

Every time you have a flare-up, you are at risk of having another flare-up again. Before you are discharged from the hospital, your healthcare team will review your medicines and COPD action plan to make sure they are up-to-date. They will also check your inhalers technique and make sure you are using them correctly to prevent the risk of future flare-ups. Sometimes, you may need to attend follow-up clinics with your doctor few weeks after discharge to make sure you are recovering well. 

How can I reduce the risk of a flare-up?

There are things you can to do reduce the risk of a flare-up, which include learning as much as you can about your COPD, and getting the right help and support to help manage your condition well. 

These include:

  • quitting smoking
  • exercising daily
  • joining a pulmonary rehabilitation programme
  • getting influenza and pneumonia vaccinations
  • taking your COPD medicines daily as prescribed by your doctor.

Read more about self-care for COPD

Learn more

Breathe easier with COPD Asthma + Respiratory Foundation, NZ
What to do in a COPD flare-up HealthInfo Canterbury, NZ

References

  1. NZ COPD guidelines 2021 Asthma + Respiratory Foundation, NZ, 2021
  2. The COPD prescribing tool BPAC, NZ, 2020
  3. An update on the pharmacological management of stable COPD BPAC, NZ, 2020
  4. Global initiative for chronic obstructive lung disease 2021 
Credits: Health Navigator Editorial Team . Last reviewed: 07 Oct 2019