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COPD flare-ups

Also known as COPD exacerbations

Key points about COPD flare-ups

A flare-up is when your chronic obstructive pulmonary disease (COPD) symptoms suddenly get worse, and you are experiencing shortness of breath or coughing.
You should act quickly and follow your treatment plan as soon as you realise your symptoms are getting worse.

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See your doctor or go to the nearest emergency department immediately if you, or someone you care for, experience the following:
being 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. A flare-up or a worsening (exacerbation) of your COPD symptoms might be triggered by an infection or there may be no apparent reason.

Signs of a flare-up include coughing or wheezing more, producing more phlegm or mucus than usual, a change in the colour and consistency of your phlegm, experiencing more shortness of breath (trouble breathing) than usual and feeling more tired.
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. It also tells you how to recognise and cope with worsening symptoms (exacerbations).
You can develop your COPD action plan with your healthcare provider and set it up to suit the severity of your COPD and your preferences.

A COPD flare-up is when your COPD symptoms become worse suddenly or are 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 CO PD.

Signs of a flare-up
Coughing or wheezing more Finding it harder to breathe than normal – being less able to do any physical exercise or do your usual daily activities. Producing more phlegm or mucus	A change in the colour and consistency of your phlegm Feeling tired – having less energy Eating less.

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 set it up so that it suits the severity of your COPD and your preferences. At each visit with your healthcare provider you can review the plan and make changes to it as needed. However, having an action plan does not replace your doctor. It enables you to start treatment early but 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.

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

COPD action plan	Blue card regional COPD action plan
(external link)	[PDF, 355 KB]
COPD action plan(external link) The Asthma and Respiratory Foundation, NZ, 2020	Blue card regional COPD action plan [PDF, 355 KB] District Health Boards, NZ, 2019

Your action plan will include instructions on changes to make to your medicines when your symptoms get worse. This may include 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 credit: 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 available 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.

Make sure you know all of the medicines you are taking and how to use them correctly. Let your pharmacist or doctor know if you find your inhaler difficult to use. They may be able to find an easier alternative.

You can also learn these breathlessness strategies(external link) to use, along with making changes to your current medicines, when you are feeling breathless.

Sometimes, you may need to go into hospital if you have a severe flare-up or exacerbation. 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:
being 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 turning blue your symptoms getting worse suddenly despite following your COPD action plan.

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 you have an infection
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 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, increases your oxygen levels and reduces the need for being admitted to an intensive care unit (ICU).

Before discharge

Every time you have a flare-up, you are at risk of having another. 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 a few weeks after discharge to make sure you are recovering well. It may take several weeks to get back to your baseline.

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

These include: