Living with chronic obstructive pulmonary disease (COPD) means you don’t breathe as well as you used to. But some days, it can seem extra hard to catch your breath, take a deep breath, or stop coughing. This worsening of symptoms is called a COPD flare-up.

An estimated 30 percent to 50 percent of people with COPD experience at least one flare-up each year. Although they’re acute (temporary), it can take weeks to recover from a flare-up, and severe cases may require hospitalization. Here’s what you need to know before your first flare-up hits.

What Is a COPD Flare-Up?

A COPD flare-up, also called a COPD exacerbation, occurs when your everyday symptoms get worse or new symptoms appear. COPD symptoms can fluctuate a little bit throughout the day, but flare-ups tend to last longer and be more serious, usually requiring some kind of medication or other intervention.

The Global Initiative for Obstructive Lung Disease (GOLD) categorizes the severity of COPD flare-ups based on the level of treatment required:

• Mild — Is treated with more frequent doses of existing medications, like inhalers
• Moderate — Is treated with rescue inhalers, antibiotics (if you have a bacterial infection), and/or corticosteroids
• Severe — Requires hospitalization

Some COPD flare-ups can develop in a matter of hours, while others take days.

How Long Do COPD Flare-Ups Last?

Flare-up durations can vary significantly from person to person and episode to episode. According to the American Lung Association, COPD flare-ups can last two or more days.

Some MyCOPDTeam members have experienced COPD flare-ups that last for weeks:

• “I've been in the hospital for two weeks. Bad flare-up. Chest is so tight, but there’s nothing more they can do.”
• “I’ve been in the hospital for the past two weeks with a severe flare-up. Still have a way to go before I’m ready to go home.”
• “Had a flare-up for three weeks. Still on five steroids a day and four nebulisers.”

“I’ve been in the hospital for two weeks. Bad flare-up. Chest is so tight, but there’s nothing more they can do.”

— A MyCOPDTeam member

About 20 percent of people with COPD report at least one lingering symptom eight weeks after the onset of a flare-up.

What Are the Symptoms of a COPD Flare-Up?

People often report the following symptoms during a COPD flare-up:

• Increased breathlessness
• Increased coughing frequency or severity
• Pain when taking a deep breath
• Changes in the color, thickness, or amount of mucus/phlegm produced by a cough
• Increased wheezing or noisy breathing
• Trouble sleeping
• Increased fatigue
• Lower oxygen levels (as measured by a pulse oximeter)

Sometimes people also feel confused or disoriented, report a fever or other symptoms of infection, or notice swelling in their feet or ankles.

Here’s how members of MyCOPDTeam describe their COPD flare-ups:

• “I had a tight chest and could not take a deep or whole breath. Labored breathing.”
• “Believe me, if you are having a bad exacerbation, you will know it. I have had three in the past, and my wife rushed me to the ER with my head out the window, gasping for air.”
• “Coughing a lot. Short of breath. Seeing the doctor tomorrow, starting to have a flare-up.”

“Coughing a lot. Short of breath. Seeing the doctor tomorrow, starting to have a flare-up.”

— A MyCOPDTeam member

What Triggers COPD Flare-Ups?

COPD flare-ups often occur in response to certain things in the environment, especially the following:

• Smoke — From cigarettes, vapes, campfires, fireplaces, burn piles, and more
• Strong odors or fumes — Cleaning supplies, perfume, scented candles or wax melts, air freshers, vehicle exhaust, and more
• Weather — Extremely hot or cold temperatures, stormy weather, wind, high humidity, and more
• Environment — Pollen, smog, air pollution, dust, and more
• Respiratory infections — COVID-19, flu, pneumonia, colds, sinus infections, and more

All of the above can irritate the respiratory system, causing inflammation, narrow airways, and mucus production. Failing to take your COPD medication as prescribed can also make your symptoms worse.

Everyone reacts to COPD triggers differently. Something that causes a flare-up in one person may not cause an issue in another person. To identify your triggers, keep a detailed log of your flare-ups and the circumstances that led up to them. You may be able to avoid some triggers, but others — like stormy weather — can be tricky to get away from.

MyCOPDTeam members share some of their triggers and what it’s like to deal with them:

• “I find watching air quality makes a very big difference, and I avoid time outdoors when it is above 89. The weather makes a big difference for me, too.”
• “Weather changes seem to trigger my breathing problems. The air purifier my kids bought me helps a lot, though.”
• “The humidity was a bit much for me today, and that seems to be a big trigger for me with my COPD.”
• “I am doing very well. I have my COPD under control for now. It really hasn’t been cold enough to trigger an attack.”

“The humidity was a bit much for me today, and that seems to be a big trigger for me with my COPD.”

— A MyCOPDTeam member

Avoiding Triggers

Smoking is the most common cause of COPD, and smoking or breathing second-hand smoke can make symptoms worse. Experts recommend quitting smoking to prevent COPD exacerbations.

It’s also important to reduce your risk of a respiratory infection by doing the following:

• Wash your hands regularly.
• Update your vaccines, as recommended by your healthcare provider.
• Stay away from people who have contagious respiratory illnesses.

Some MyCOPDTeam members also rely on air purifiers to remove triggers like dust and pollen from indoor air:

• “I’ve bought an air purifier, and I find it helps with air pollution, acting as an irritant.”
• “Desert areas are so dusty anyway, and my purifier really helps.”
• “I have two large air purifiers in a large room with high ceilings. We have three dogs. The purifiers help A LOT.”

What Should You Do During a COPD Flare-Up?

Mild COPD flare-ups can typically be treated at home with bronchodilators, steroids, and antibiotics. Your healthcare provider will write you a prescription for these medications so you can have them on hand in the event of a flare-up. You may hear it called a rescue pack.

Everyone’s rescue pack looks a little different, so it’s important to talk to your doctor about when to use each medication.

Typically, you’ll use bronchodilators (through an inhaler or nebulizer) when you’re coughing or having trouble breathing. These fast-acting drugs help the airways open and relax so that you can take deeper breaths. Depending on the severity of your COPD, you may be advised to use certain inhalers every day or right before physical activity to help prevent flare-ups. Other inhalers are only intended for flare-ups, not for everyday maintenance.

Corticosteroids can be inhaled or taken orally. They reduce inflammation around the airways to make it easier to breathe. Like bronchodilators, steroids might be taken daily or on an as-needed basis to prevent or treat flare-ups. In the event of a severe flare-up, corticosteroids can also be delivered intravenously at the hospital.

Antibiotics may be included in your rescue pack to help you quickly treat infections before they trigger a flare-up. Antibiotic resistance is a significant concern, so antibiotics should only be used to treat a known infection, not to prevent one.

When To Seek Emergency Care

A COPD flare-up can become a life-threatening emergency if you’re unable to get enough oxygen. Call 911 or ask someone to drive you to the nearest emergency room if you notice any of the following symptoms:

• Inability to breathe, such as gasping or choking
• Tight or heavy chest
• Blue lips, skin, or fingernail beds
• Pain that spreads to your neck, jaw, back, and arms
• Rapid heartbeat
• Slurred speech
• High fever
• Brain fog
• Difficulty concentrating
• Sudden confusion
• Headache upon waking
• Difficulty waking

You should also seek immediate medical care if you experience a mild or moderate COPD flare-up but don’t have access to your rescue pack. Delayed treatment could lead to lung failure.

Join the Conversation

On MyCOPDTeam, people share their experiences with COPD, get advice, and find support from others who understand.

What seems to trigger your COPD flare-ups? What symptoms do you experience? Let others know in the comments below.