How to manage a COPD flare-up

A flare-up (also known as an acute exacerbation) is when COPD symptoms suddenly get worse for a while. A COPD flare-up can be terrifying when it happens, as it can come on unexpectedly and can last for a long time. 

Being prepared for a flare-up can make the experience easier to manage. Knowing how to prevent an episode may reduce the number of times you experience a flare-up. 
This information was sourced from leading COPD health and advocacy organisations. This is general information and should not be taken as medical advice. Please consult someone from your medical team if you have specific questions about your COPD or general health.

What are the signs of a flare-up?

Your symptoms may feel better or worse occasionally. However, if your symptoms are worse for two or more days, you may be experiencing a flare-up.
Some common signs during an acute exacerbation (flare-up) include:

• Increased coughing²
• Changes in colour, thickness, or amount of phlegm (mucus brought up from the bottom of the lungs)²
• Difficulty sleeping²
• Shortness of breath or having a hard time taking a deep breath²
• Wheezing or noisy breathing²
• More fatigue or tiredness
   

What causes a COPD flare-up?

Commonly, a flare-up is caused by an infection from a virus or bacteria. You may also find cold weather makes your symptoms worse. Together, this means that flare-ups can be more common in the winter months. 
 

Some people have triggers which are more likely in the summer, like hot weather, bad or worsening air pollution, high pollen count and dust. Other triggers include smoking, forgetting to take your regular COPD medication³, doing too much physical activity, being run-down, or feeling stressed or anxious.
It's important to recognise your usual COPD symptoms and sleep patterns. This can make it easier to detect a flare-up when you have one.

What can I do while I am experiencing one?

If you believe you are having a flare-up, it is important to talk to your GP or healthcare provider about your signs or symptoms. Together, you can work to develop a personalised action plan to help manage your condition and prevent further episodes.
Your action plan may include a rescue pack. A rescue pack is a supply of standby medications to take if your COPD gets worse before you can see your GP.
It could include either or both of two different COPD rescue medications:

• Steroids
• Antibiotics

If you need to start taking your rescue pack, please let your GP know as soon as possible. They may arrange an appointment to review you and ensure you are getting the correct treatment.

After taking your rescue pack, your condition should settle and get back to normal again after a period of recovery. If your symptoms do not improve within 48 hours of taking your rescue pack or following your rescue plan, or if they worsen, please contact your doctor immediately. In an emergency, go to the hospital.
After completing your rescue pack, you should make another appointment to see your doctor to review your condition. You may also get a replacement rescue pack at this appointment if appropriate.

Recovery

It is normal to feel overwhelmed and anxious once recovering from a COPD flare-up. Some tips for easing back into your typical routine include:

• Drink plenty of fluids, especially water
• Make sure you rest often and preserve your energy
• Manage your breathing through exercises
• Take your inhalers as prescribed
• Gradually take part in small amounts of exercise when you feel ready. This can include stretching exercises or a small walk inside.

Recovery looks different for everybody. It may take weeks rather than days to return to your usual self. You may also feel weaker after a flare-up, because you have been doing less and may have been on steroids during this time⁸. Although it will take some time and effort, it is possible to return to your normal again.

How can I prevent a flare-up from happening?

A flare-up can happen anytime. However, there are ways to make them happen less often.
Stopping smoking has the best chance of avoiding frequent flare-up episodes. Smoking makes your COPD worse and makes your chest less sensitive to your COPD treatment³. Stopping smoking has the greatest capacity to influence the natural progression of your COPD. 

Pulmonary rehabilitation can also help you reduce the number of flare-ups you experience. Research shows that pulmonary rehabilitation is one of the best things you can do to improve your breathing and well-being⁹. Pulmonary rehabilitation is usually a 6 week course that includes exercises, learning about breathing techniques, nutrition tips, and methods to help manage worry and stress that impacts people with a COPD condition. Learn more about the benefits of pulmonary rehabilitation in our blog, ‘Pulmonary rehabilitation: what is it?’.

Following COPD treatment can help cut down the chance of another flare-up. You can create a treatment plan that works for you and your needs with your medical team. Find out more about your COPD treatment options here.

1. 1. https://www.asthmaandlung.org.uk/conditions/copd-chronic-obstructive-pulmonary-disease/managing-copd-flare-ups#treated
2. 2. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/living-with-copd/prevent-flare-ups
3. 3. https://www.nth.nhs.uk/resources/chronic-obstructive-pulmonary-disease-copd-and-exacerbations-or-flare-ups/
4. 4. https://www.healthline.com/health/avoiding-copd-triggers#weather
5. 5. https://medlineplus.gov/ency/patientinstructions/000698.html
6. 6. https://www.royaldocksmedicalpractice.co.uk/copd-rescue-pack-information 
7. 7. https://www.mylungsmylife.org/topics/group-1/recovering-from-an-exacerbation/recovering-from-an-exacerbation-2/ 
8. 8. https://www.glastonburysurgery.co.uk/wp-content/uploads/sites/701/2020/07/COPD-SELF-MANAGEMENT-PLAN-FOR-EXACERBATION-2020.pdf
9. 9. https://lungfoundation.com.au/blog/tips_for_recovering_from_a_copd_flare-up/ 
10. 10. https://www.asthmaandlung.org.uk/living-with/keeping-active/pulmonary-rehabilitation