When you know how a typical day feels with chronic obstructive pulmonary disease (COPD) that is being managed properly, you can begin to recognize how it feels when it is getting worse.
Days when your symptoms of COPD feel worse are described as flare-ups. You may also hear a doctor refer to them as acute exacerbations.
Flare-ups can feel different for everyone, but some signs to look out for include:
- more coughing than usual
- difficulty falling and staying asleep
- difficulty taking deep breaths
- more tiredness than usual
- wheezing
- changes to the color or amount of phlegm
It’s important to know more about what can trigger a flare-up and how to manage those days when your symptoms worsen.
What is a COPD flare-up?
COPD is the term for a group of long-term lung diseases that gradually damage your lungs over time. According to the World Health Organization (WHO), the most common symptoms of COPD are coughing and tiredness.
COPD is a progressive disease, and as the condition of your lungs worsens, phlegm can build up in your airways. This causes coughing and wheezing, which makes taking deep breaths difficult. Difficulty breathing often results in tiredness and fatigue.
A flare-up, or an exacerbation, is a sudden worsening of the symptoms (especially dyspnea — the medical term for shortness of breath) that signals that you may need to alter your treatment plan. The laboratory criteria for an exacerbation include at least 4% lower oxygen levels in the blood than when the condition is stable.
Definitions of what constitutes a flare-up may vary, but severe flare-ups can deeply affect your health and possibly lead to hospitalization, so knowing what to look out for can help you avoid severe events.
Symptoms of a flare-up
The first thing that people with COPD often notice is that they become more out of breath than usual when exercising. During a COPD flare-up, your symptoms of COPD can get worse and more difficult to manage than usual.
It can help you recognize a flare-up if you know what a typical day feels like. Take note of how your symptoms feel when you are managing your COPD with treatment.
Early symptoms of a flare-up to watch out for include:
- sudden increase in shortness of breath (dyspnea), especially while at rest
- changes to the color and volume of phlegm, for example, blood-tinged or green
- more coughing
Symptoms that may get worse during a flare-up include:
- feeling more tired than usual
- excessive coughing
- wheezing more than usual
- increased ankle swelling
- low grade fever
- your oxygen levels are lower than usual
- difficulty taking long, full breaths
Sometimes if a flare-up is severe, you may need to seek medical attention to help manage your symptoms. In some cases, you may need to go to the hospital.
In addition, your lungs are responsible for exchanging carbon dioxide for oxygen. COPD symptoms can make it difficult to breathe, and if your symptoms become severe, carbon dioxide can build up in the body, and your oxygen levels will become too low. This can be serious and require emergency treatment.
Having too much carbon dioxide in your body can cause:
- severe headaches
- chest pain
- inability to take full breaths
- rapid heart rate
- confusion
What are the triggers?
Research states that most flare-ups happen because of infections in the lungs or from environmental triggers like air pollution. There are also certain characteristics that can put you more at risk of having flare-ups.
Smoking is one of the most common causes of COPD, and if you continue to smoke after developing it, you may be more at risk of flare-ups. One 2016 review of studies also suggests that air pollution can increase the risk of flare-ups.
Some research notes that having previously experienced a flare-up can increase your chances of having another one in the future. The risk is tripled after experiencing 2 severe flare-ups, and it’s increased by 24 times after experiencing 10 exacerbations.
Different infections from viruses or bacteria can increase levels of inflammation, potentially leading to an exacerbation, including:
Finally, there are certain other conditions that, if you have them alongside COPD (known as comorbidities), can increase the risk of flare-ups. This 2018 review notes the following conditions as possible comorbidities that might lead to flare-ups:
- high blood sugar
- high blood pressure
- depression
- anxiety
Prevention tips
It is not always possible to prevent a COPD flare-up. But there are steps you can take to reduce your risk of COPD flare-ups, such as adopting certain lifestyle practices and avoiding triggers.
Examples of steps you can take include:
- getting the flu vaccination each year
- getting the pneumococcal vaccine
- stopping smoking and avoiding second-hand smoke
- drinking plenty of fluids to prevent thickening mucus
- regularly visiting a healthcare professional to monitor your condition
- washing your hands frequently to avoid becoming sick
- monitoring your oxygen levels with a pulse oximeter, if possible
Some research notes that education and self-management programs can help you manage your condition at home, which can prevent future flare-ups. Some research finds that these can lead to a 40% reduction in hospitalization for COPD patients due to flare-ups, but this review notes that evidence is mixed.
Treatment
If you have COPD, it may be a good idea to create an action plan that you can refer to if you experience a flare-up. This is a personal set of instructions that includes what you need to do if your symptoms worsen.
How you manage a flare-up will depend on its severity. You likely notice a pattern already that warns you when you are feeling a flare-up coming. If you take note of early signs, you can receive treatment before your symptoms become severe.
At home
At-home treatments can include:
- Steroids: These include medications that can reduce inflammation in your lungs, allowing your airways to open and making breathing easier. One example is methylprednisolone (Medrol).
- Inhalers: Bronchodilators and steroids come as inhalable medications. This helps the medications work faster. While steroids help reduce inflammation, bronchodilators help open your airways. These include levalbuterol (Xopenex) and albuterol (Ventolin HFA).
- Antibiotics: If a flare-up is the result of a bacterial infection, antibiotics can help stop your symptoms from worsening.
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