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.

An acute exacerbation -- those symptoms that put you in the "red zone," like fever, shaking chills, confusion, chest pain, and coughing up blood -- can land you in the hospital. That's more likely when you've had at least three flare-ups in the past year or you have severe COPD (even without a flare-up).

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 right away if you or a loved one with COPD is 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 can be 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. Here are some tips that may help you limit COPD flares.

Call your doctor

Talk to your doctor if you have any of the early warning signs listed above. These can signal that you're about to have an exacerbation or are already having one. Maybe you try to tough it out when you get sick. Or you rarely call the doctor because you "hate to be a bother."

You'll need to break out of those mindsets. A flare-up of COPD isn't something you should wait to run its course. A prescription for medicine, such as antibiotics or steroids, may help you get better at home instead of in the hospital.

Different ways of treating mild exacerbations are also being tried, like in-home care supervised by a respiratory nurse with help from a hospital team. Studies of comprehensive care management programs, involving a coordinated team that may include people like your doctor, your respiratory therapist, and an equipment provider, suggest that this approach may help prevent hospital readmissions.

Keep a positive attitude

Hundreds of studies link stress with a weakened immune system, and when you have COPD, that could mean flare-ups and trips to the hospital. Anxiety and depression can lead to flares and hospital stays, too. What's worse is that you may not realize you're dealing with these mental health concerns, because they seem normal to you.

Let your doctor know if you:

  • Worry most days
  • Are restless and easily irritated
  • Often feel sad or hopeless, and that affects your daily life

Medication and different types of therapy can treat mental health issues, which may improve your chances of staying out of the hospital.

A sunnier outlook and feeling good about yourself can help you stay on track with the things you need to do to take care of your COPD. Simple practices can foster a sense of peacefulness and lift your spirits:

  • Listen to soothing or cheerful music.
  • Watch a funny movie.
  • Turn off the news.
  • Avoid people or conversations that upset you.
  • Meditate or use guided imagery.
  • Do gentle yoga or tai chi.

Up your air quality

The most common cause of a COPD flare-up is poor air quality, indoor and out. So clean up your air.

Start by removing clutter, which attracts dust mites. Get your air conditioner inspected for mold and mildew. Consider using an air filter. Avoid fumes from cleaning products, perfumes, and paint, which may trigger flare-ups. Stay away from tobacco smoke and pet dander.

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

  • Keep regular appointments with your doctor, even if you’re feeling fine at the time.
  • Get your flu shot every year, and stay away from crowds during cold and flu season. 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.
  • Make sure you're using your medications, including oxygen, correctly. Ask your doctor for a refresher about when and how they work their best.
  • Tell your doctor if you have trouble paying for any treatment or are bothered by side effects.
  • Wash your hands often with warm water and mild soap.
  • Use hand sanitizer when you can’t wash your hands.
  • Use your own pen at the doctor's office.
  • 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

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