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Medical News Today: Exacerbation of COPD: Causes, Warning Signs, and Treatment

MNT Knowledge Center

Chronic obstructive pulmonary disease is a group of diseases that cause airflow blockage and extreme breathing problems to the point of breathlessness.

Most commonly referred to as COPD, the term describes emphysema and chronic bronchitis. COPD also includes bronchiectasis and, in some patients, asthma. COPD gets worse as it progresses and, in late stages, a person may experience extreme breathlessness at all times, even when they are sitting still. COPD often goes undiagnosed and can be life-threatening if not properly treated.

An acute exacerbation of COPD refers to a flare-up or episode where a person’s breathing becomes worse than normal. This can lead to life-threatening complications depending on the cause and severity.

Causes of COPD exacerbations

In most cases, a COPD exacerbation can be linked directly to an infection within the lungs or the body. The infection is typically the result of a virus but can also be caused by bacteria or other organisms.

pollution from a factory
A COPD exacerbation may be a result of environmental factors such as air pollution.

The infection causes inflammation within the lungs, which leads to narrowing of the airways. The airways become blocked due to swelling and mucus production.

Exacerbations can also occur as the result of a severe allergy or from inhaling irritating substances from the environment, including heavy air pollution. Other causes include:

  • Weather changes
  • Doing too much activity
  • Not getting enough sleep or being run down
  • Being under stress or feeling anxious

In some cases, the exact cause is unknown.

Signs and symptoms

Exacerbations can come on quickly and sometimes with little warning. Typical tests such as chest X-rays and blood tests are often unable to detect the severity of an exacerbation, so understanding the early signs are important. It is important for patients to be aware of even slight changes in their typical symptoms.

People with COPD are their own best defense against exacerbations. By understanding the signs and symptoms, they can get help right away to limit complications of a flare.

The signs and symptoms of exacerbations are related to the change from a person’s usual condition. These include:

  • More wheezing than normal
  • Persistent cough
  • Extreme shortness of breath that is worse than usual or shallow or rapid breathing
  • Large increase in mucus production
  • Change in the color of mucus, which may be yellow, green, tan, or bloody
  • Fever
  • Confusion or sleepiness
  • Swelling in the feet or ankles

Treatment and prevention

Exacerbations can be severe and life-threatening. At the first sign of symptoms, a person should seek immediate medical care. Depending on the severity and cause, patients will often require hospitalization. Sometimes exacerbations can be managed at home, depending on a person’s overall health.

oxygen therapy being administered by a doctor on a patient
In certain situations, COPD exacerbations may be treated at home using oxygen therapy.

Treatments include:

  • Oxygen therapy
  • Glucocorticosteroids
  • Antibiotics for bacterial lung infections
  • Antiviral medication for flu
  • Bronchodilators
  • Respiratory stimulants
  • Respiratory or ventilator support

The frequency of COPD exacerbations can vary depending on the person, and a variety of conditions contribute to exacerbations. A 2014 report in PLOS One showed that patients who were older, female, had poorer lung function, had a history of exacerbations in the previous year, and who had a frequent cough with phlegm were more likely to have to have one or more exacerbations the following year.

People who experience recurrent exacerbations have a faster decline in lung function and increase their mortality risk, especially if they have to be hospitalized. Those who experience a mild flare-up will be prescribed medication at home.

Exacerbations need to be treated right away because it can take a while for someone to recover from them. Episodes caused by respiratory infections can result in increased mucus production, inflammation, and loss of lung function. Those who have a viral illness are at an increased risk for developing a secondary bacterial infection.

Outside of treatment for the flu, there are no medications that can slow a viral lung infection once it starts. Not all COPD exacerbations can be prevented, especially in the advanced stages of COPD. However, there are things that individuals can do to try to limit their occurrence and severity.

Quitting smoking is the most important thing any person with lung disease can do to improve their medical condition and quality of life. Enrolling in a smoking cessation program can help a person who cannot quit on their own.

Other things that can help prevent exacerbations include:

  • Keeping all regularly scheduled appointments with doctors and keeping up with medication regimens. A doctor can monitor a patient’s progress as well as prescribe any other medication needed for both maintenance and treatment.
  • Getting vaccinated. The influenza virus is very dangerous for people who have COPD and can cause life-threatening exacerbations and complications. The pneumonia vaccine and the whooping cough vaccine are also recommended in order to prevent these infections.
  • Washing hands often with soap and water to minimize the transfer of viruses, bacteria, and other germs. People with COPD can carry a bottle of hand sanitizer for a quick clean up.
  • Getting plenty of rest. Exacerbations are more likely to occur if a person with COPD is not getting enough sleep or rest.
  • Exercising, participating in pulmonary rehabilitation, and following a balanced diet. Being overweight or underweight increases the risk of problems in COPD.
  • Avoiding pollutants and irritants.
  • Staying away from crowded places during flu and cold season.

It is important that people with COPD understand the dangers their condition poses and have a home management plan in place. Depending on their age, severity of their COPD, frequency of exacerbations, as well as other medical conditions, some people must be hospitalized.

Signs of increased severity include worsening breathing, fluid buildup in the lower legs, chest pain, no improvement of symptoms with home medications, and mental confusion. Any of these symptoms require immediate medical attention.

For people who can be managed at home, there should be clear instructions about the use of medication and treatment therapy, as well as when to call the doctor. Some people may be prescribed supplemental oxygen therapy, which can also be used at home.

COPD overview

Tobacco smoke, including secondhand smoke, is the primary cause of COPD. The disease typically progresses faster in those who are exposed.

Older man coughing
Alongside shortness of breath, a chronic cough is a typical symptom of COPD.

Other risk factors include:

  • Indoor air pollution, which includes solid fuel used for cooking and heating
  • Outdoor pollution
  • Occupational dusts and chemicals including vapors, irritants, and fumes

Shortness of breath is one of the most common problems that COPD patients have, but there are typically other symptoms. These can include:

  • A chronic cough
  • Frequent respiratory infections
  • Blueness of the lips or fingernail beds
  • Fatigue
  • Wheezing
  • Production of a large amount of mucus

Lung function in COPD is typically classified from mild to very severe. One way to check the severity of the disease is to measure airflow limitation.

People with stage 1 COPD have the best lung function while those in stage 4 have the worst. All COPD patients are at risk, but those with the most severe airflow limitations are the least tolerant to COPD exacerbations.


Exacerbations are major setbacks for people with COPD. Understanding the risk factors and recognizing the symptoms may mean that a person can get the treatment they need before their situation becomes life-threatening. Although people in the later stages of COPD may need to go to the hospital, those people with less severe exacerbations may be able to manage at home.

People with COPD and their caregivers should work alongside their doctor and medical team to ensure that everyone understands what should be done when exacerbations occur.

The key to preventing or lowering the risk of exacerbations is understanding the risk factors, knowing the signs and symptoms, and having an action plan in place.

Written by Brian Wu



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