COPD flare-ups

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.

What is a COPD flare-up?

A COPD flare-up is when your COPD symptoms become worse 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 tried – have less energy
  • Eating less

How is a flare-up managed?

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


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.

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 things don’t improve within 2 days of starting the medicines you keep at home.

Can I reduce the risk of a flare-up?

There are things you can to do reduce the risk of a flare-up, including:

  • quit smoking
  • exercise daily
  • join a pulmonary rehabilitation programme
  • get influenza and pneumonia vaccinations
  • take your COPD medicines daily as prescribed by your doctor.

Get immediate medical attention

If your COPD symptoms have changed a lot and you are worried, get immediate medical attention.

Get immediate medical attention – call 111 if you have the following symptoms:

  • very short of breath when sitting or lying down
  • feeling unusually restless, confused or drowsy
  • chest pain
  • swollen ankles
  • slurred speech.

Learn more

Breathe easier with COPD Asthma Foundation, NZ

Credits: Health Navigator Editorial Team . Last reviewed: 07 Oct 2019