Signs of a COPD Flare-Up

When you have chronic obstructive pulmonary disease, or COPD, your usual symptoms might become worse rather quickly -- or you may even get new ones.

You may hear your doctor or nurse call this an “exacerbation.” Think of it as a flare-up. During one of these bouts, you may suddenly have more trouble breathing or make more noise when you do.

These flare-ups are often linked to a lung infection caused by a virus or bacteria, such as a cold or some other illness. Smoggy or dirty air can also make your symptoms get worse in a hurry.

It’s important to know the warning signs that a flare-up is coming on so that you can avoid it if possible. These exacerbations can cause your COPD to get worse or put you in the hospital.

Early Warning Signs of a Flare-Up

Self-awareness is important with COPD flare-ups. Only you can know how you feel on a typical day -- how your breathing feels and how much you cough. Pay close attention when things change.

One obvious sign of an oncoming flare-up is shortness of breath. You feel like you can’t get enough air. You might notice it during light physical activity or even when you are at rest.

Other things you should watch out for:

  • Noisy breathing. Your breath makes strange noises. Wheezing suggests mucus or pus is blocking your airways. Gurgling or rattling could mean fluid in your lungs.
  • Irregular breathing. You feel like you have to use your chest muscles to breathe instead of your diaphragm. Your breathing becomes uneven. Sometimes your chest moves a lot faster; sometimes it’s much slower.
  • Worse coughing. It’s more severe or you cough more often than usual. It could be dry or bring up yellow, green, or bloody phlegm. It gets worse when you lie down -- so much that you may have to sit in a chair to sleep.
  • Changes in skin or nail color. You see a bluish tint around your lips or notice that your nails seem blue or purple. Your skin looks yellow or gray.
  • Trouble sleeping and eating. You can’t get to sleep, and you don’t feel like eating.
  • You can't talk. You're unable to get any words out. You have to use hand gestures to let someone know something is wrong with you. This is a late and dangerous sign of worsening breathing.
  • Early-morning headaches. You start the day with a throbbing head because of a buildup of carbon dioxide in your blood.
  • Swollen ankles or legs or belly pain. These symptoms are linked to problems with your heart or lungs.
  • Fever. A higher temperature could be a sign of infection and an oncoming flare-up.

You should call your doctor at once if you or a loved one with COPD are showing symptoms of a flare-up.


When to Get Emergency Care

Sometimes, your flare-up could start to become severe. You might not have enough time to wait for a visit to your doctor’s office. Call 911 if you have these symptoms:

  • Chest pain
  • Blue lips or fingers
  • You’re confused or get very easily upset
  • You’re so short of breath you can’t talk

Severe COPD flare-ups are potentially life-threatening, so fast action is important with these symptoms.

How to Avoid Flare-Ups

Of course, the best thing that can happen is to avoid as many flare-ups as possible in the first place. One thing you should do is to schedule and keep regular appointments with your doctor, even if you’re feeling perfectly fine at the time.

Here are some other tips to keep COPD flare-ups at bay:

  • Get your flu shot every year. Pharmacies and grocery stores often offer these shots for free at the start of flu season.
  • Ask your doctor whether you are due for a pneumonia and pertussis shot.
  • Wash your hands often with warm water and mild soap.
  • Use hand sanitizer when you can’t wash your hands.
  • Try to stay away from crowds during cold and flu season.
  • Drink enough water to stay hydrated.
  • Take sleep time seriously. When your body is tired, you’re more likely to get sick.


WebMD Medical Reference Reviewed by Minesh Khatri, MD on March 14, 2019



Breathe: The Lung Association (Canada): “Chronic Obstructive Pulmonary Disease -- Flare-ups.”

COPD Foundation: “Staying Healthy and Avoiding Exacerbations.”

Neil Schachter, MD, professor of pulmonary medicine and medical director of Respiratory Care Department, Mount Sinai Center, New York.

Care Community: “Caring for Others: Breathing Problems.”

European Respiratory Journal: “Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.”

National Lung Health Education Program: “Lung -- COPD and Asthma.”

National Heart, Lung, and Blood Institute: "COPD: Learn More Breathe Better."

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