COPD Exacerbations: Warning Signs, Triggers, and Treatments

Medically Reviewed By Adithya Cattamanchi, M.D.
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A chronic obstructive pulmonary disease (COPD) exacerbation, or COPD flare-up, is when COPD symptoms suddenly become worse. This can interfere with breathing and supplying oxygen to the body. A COPD exacerbation can last for hours or over a period of days. For some people, a flare-up can be uncomfortable yet short-lived by following their action plan at home. For other people, a flare-up can be very severe, requiring hospitalization.

With advanced COPD, an untreated flare-up could lead to death.

According to the Centers for Disease Control and Prevention (CDC), 16 million people in the United States have COPD, which includes periods when symptoms suddenly worsen.

Effective COPD exacerbation treatment includes knowing your triggers, identifying symptoms, and following an action plan. Working to minimize flare-ups can help improve the quality of life with COPD. 

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Santi Nuñez/Stocksy United

This article includes information on what causes a COPD exacerbation, how to treat it, when to call your doctor, and steps you can take to prevent it.

What is a COPD exacerbation?

COPD exacerbation is the worsening of COPD symptoms in a short period of time, which could be hours to days. A COPD exacerbation requires additional treatment beyond a person’s regular COPD medication and therapies.

As COPD progresses, it typically reduces lung function, making it harder to breathe and supply oxygen to the rest of the body. COPD progression can lead to frequent episodes of COPD exacerbation, severe breathlessness, respiratory failure, and death.

A 2016 study published in the American Journal of Epidemiology found the average rate of COPD exacerbation was 1.53 episodes per year, with 95% of the study participants experiencing between 0.47 and 4.22 episodes per year.

What are early warning signs of COPD exacerbation?

COPD exacerbation symptoms go beyond usual COPD symptoms. 

Usual COPD symptoms include:

With a COPD exacerbation, these symptoms tend to get worse and do not go away even with regular COPD treatments. 

Additional symptoms that can accompany an exacerbation include: 

  • abdominal pain
  • anxiety
  • blue or purple lips or nails
  • difficulty sleeping
  • difficulty speaking 
  • an inability to take deep breaths
  • morning headaches
  • swelling in the legs or ankles

When to call your doctor about a COPD exacerbation

Managing your COPD exacerbations at home is possible, but it is important to know when to contact your doctor to prevent more serious conditions.

If you have taken steps to alleviate a COPD exacerbation and your breathing is not improving, call your doctor or a member of your COPD team. 

Seek emergency medical care (call 911) for these other serious COPD exacerbation symptoms that indicate your flare-up is getting worse: 

  • fever 
  • chest pain 
  • more frequent headaches 
  • coughing up dark mucus
  • leaning forward to breathe more easily 
  • feeling sleepy or confused 

If your daily medications are not controlling your symptoms, talk with your doctor. It is possible your doctor may increase your medication dose or suggest a different medication. Also, discuss your self-care strategies, such as maintaining a moderate weight and managing stress.  

COPD exacerbation key points

  • COPD exacerbation is an acute worsening of respiratory symptoms
  • Additional symptoms include anxiety, difficulty sleeping or speaking, morning headaches, abdominal pain, and swelling of the legs or ankles. 
  • The most common cause of COPD exacerbation is a bacterial or viral respiratory infection.
  • COPD exacerbation requires additional treatment beyond daily COPD treatment.
  • Treatment goals for COPD exacerbation are to manage current symptoms and prevent future exacerbations.
  • Treatment may include quick-relief bronchodilator, systemic corticosteroids, antibiotics, and anti-inflammatory medication.
  • Following a COPD exacerbation action plan may prevent hospitalization due to a flare-up.

What causes COPD exacerbation?

COPD exacerbation causes and triggers include illness as well as environmental changes.

Viral or bacterial infection

One of the primary causes of COPD exacerbation is inflammation in the lungs due to a viral or bacterial infection. This inflammation can cause the airways in the lungs to narrow, swell, or get clogged with mucus. The effects on the lung’s airways lead to an exacerbation.

One study compared hospitalization time and lung function impairment in people who had a COPD exacerbation. Researchers found that those who had a viral or bacterial infection had longer hospitalization times and more impaired lung function than those who did not.

Other causes and triggers

Other common COPD exacerbation causes and triggers include:

  • exposure to smoke or other air pollution 
  • changes in the weather 
  • overworking yourself 
  • increased stress or anxiety
  • being run-down 

Not all COPD exacerbations are the same. They are as individual as the person who experiences them, and the same can be said for causes of COPD exacerbation. 

For this reason, it is important to keep a symptoms diary and note when a COPD exacerbation occurs, what symptoms you had before and during the flare-up, and any changes in your health, in the weather, or at work.

These observations can help you identify your individual COPD exacerbation triggers. Share this information with your doctor. 

How do you treat a COPD exacerbation?

Following a COPD exacerbation action plan that you and your doctor design together may prevent hospitalization from a flare-up.

Many people with COPD have an action plan for worsening symptoms, including an exacerbation.

An action plan is a list of instructions to follow if you think you are having an exacerbation. For example: 

  1. Once you recognize the beginning symptoms of a COPD exacerbation, it is important to stay calm.
  2. Following your individual action plan, take your prescribed medications as directed. This usually includes a quick-relief bronchodilator, which you may use as an inhaler or with a nebulizer.
  3. Try pursed-lip breathing to help you relax. With this breathing technique, you inhale and exhale with your lips puckered. This makes your breathing more intentional and helps slow it down.
  4. Contact your COPD doctor and tell them you had or are having an exacerbation.

If your symptoms do not resolve, you may need additional medications to treat a COPD exacerbation. These treatments may or may not require hospitalization.

For instance, if your airway is constricted and your exacerbation medications do not alleviate the tightness, your doctor may prescribe steroids by pill or intravenous drip, which requires hospitalization. 

When do doctors use antibiotics to treat COPD exacerbation?

In addition to your regular COPD and exacerbation medications, your doctor may prescribe antibiotics if a bacterial lung infection is a potential cause of the exacerbation. COPD exacerbation antibiotics can help reduce exacerbation severity. 

For people who are susceptible to COPD exacerbations, doctors may prescribe medications from a variety of drugs and therapies to prevent or reduce the risk of exacerbations. These can include azithromycin (Zithromax), which is an antibiotic, and roflumilast (Daliresp), which is an anti-inflammatory.

Take steps to prevent a COPD exacerbation 

Knowing your individual COPD exacerbation causes can go a long way in keeping flare-ups to a minimum. Evaluate the circumstances leading up to the flare-up so you can start addressing the cause.

For instance, if you have been working a lot of late hours and feel stressed at work, make it a point to leave the office on time, or even early, and go to bed earlier than usual to get some extra sleep. 

Other ways to prevent COPD exacerbations include:

  • Take your daily medications as directed. COPD symptom control is an important part of preventing exacerbations.  
  • Avoid anyone with a cold or flu, along with indoor crowded places. These exposures increase the chances of contracting a respiratory infection.
  • Wash your hands often to protect yourself from infections. 
  • Get your flu shot every year and other vaccinations for respiratory infections, such as COVID-19 and pneumonia (pneumococcal vaccine).  
  • Keep your air at home clean by routinely changing out the air filters on your heating and air system. 
  • Maintain a nutritious diet, exercise regularly, take breaks to reduce stress, and drink water to stay hydrated. 
  • Know when to call your doctor about a COPD exacerbation.


COPD exacerbation occurs when COPD symptoms quickly worsen over a short period of time, which can be hours or days, and require additional treatment beyond someone’s normal treatment routine.

For some people, a COPD exacerbation can be uncomfortable, but not serious, and home treatment with medications is effective. For others, exacerbation is more severe. Symptoms may require hospitalization or even lead to death.

COPD exacerbations can result from viral or bacterial infections. Triggers also can include environmental factors such as exposure to secondhand smoke or changes in the weather. In many cases, effective treatment and prevention of COPD exacerbation includes taking medications, avoiding triggers such as air pollution, and following a healthy diet and exercise routine.

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Medical Reviewer: Adithya Cattamanchi, M.D.
Last Review Date: 2022 May 27
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