COPD flare-ups (exacerbations): recognising them and what to do

COPD is a group of lung conditions that cause breathing difficulties, including emphysema and chronic bronchitis. The NHS says the symptoms usually get gradually worse, and that there may be periods when they get suddenly worse, known as a flare-up or exacerbation.

Asthma + Lung UK explains that it is normal for COPD symptoms to change from day to day, but if they suddenly get worse you may be having a flare-up. Flare-ups matter because each one can leave the lungs a little worse than before, which is why avoiding and treating them promptly is a central part of COPD care.

Asthma + Lung UK lists the common symptoms of a COPD flare-up, which are changes from your usual pattern rather than any single symptom.

• Feeling more out of breath than usual.

• Coughing more than usual.

• Having more phlegm (sputum) than usual.

• Changes in the colour of your phlegm.

• Wheezing more than usual, feeling very tired, and finding it harder to exercise or be active.

• Feeling confused, or swollen ankles.

Asthma + Lung UK says to call 999 or go to A&E immediately if you are finding it very hard to breathe (you might be gasping, choking or not able to speak), your chest feels tight or heavy, you have pain that spreads to your arms, back, neck and jaw, your lips or skin are turning very pale or blue, or you feel confused suddenly.

For less severe worsening, follow your self-management plan and contact your GP surgery, respiratory nurse or NHS 111 if you are unsure or not improving.

Chest pain and coughing up blood can also occur in COPD, but the NHS says these are usually signs of another condition such as a chest infection or possibly lung cancer, so they need to be assessed.

Asthma + Lung UK says that if you have less severe symptoms you can treat them at home by following your self-management plan, which usually involves using a reliever inhaler (short-acting bronchodilator) and taking medicines such as oral steroids and antibiotics.

Asthma + Lung UK says recovery is different for everybody. Flare-ups usually last seven to ten days, but it might take longer to feel completely back to normal. Most people fully recover within four to six weeks, but some people never feel as well as they did before, and 1 in 5 people still have symptoms eight weeks after a flare-up.

It says that whether treated at home or in hospital, you should have a follow-up appointment with your GP when you feel better, to make sure your COPD is under control and to prevent future flare-ups. If you use three or more courses of oral steroids or antibiotics within a year, your healthcare professional should offer a review to check you are getting the right care.

Asthma + Lung UK lists the main measures. The NHS says if you smoke, stopping is the most effective way to prevent COPD getting worse, and that it is never too late to stop.

• Get help to stop smoking.

• Use a COPD self-management plan, and use the best treatments for you.

• Check you are using medicines properly, including your inhaler technique.

• Have vaccines you are offered, including flu, COVID-19, RSV and pneumococcal vaccines.

• Ask whether you need to see a lung specialist or attend pulmonary rehabilitation classes.

• Avoid triggers such as respiratory infections, indoor and outdoor air pollution, allergies, pollen, smoking and vaping, and cold or hot weather.

The NHS describes pulmonary rehabilitation as a specialised programme of exercise and education, usually 2 or more group sessions a week for at least 6 weeks, which can improve how much exercise you can do before feeling out of breath and your confidence and emotional wellbeing.

The NHS says that if you have frequent flare-ups, a GP may suggest adding a steroid inhaler to a long-acting bronchodilator, and may consider tablets such as theophylline or a mucolytic such as carbocisteine. A doctor or nurse will advise on how to use an inhaler correctly and how often.

On the NHS, flare-ups are managed by the GP surgery, respiratory nurses and community respiratory teams, with hospital admission or virtual ward care for more severe episodes. Review after a flare-up is part of routine care.

Private respiratory consultations can review inhalers, rehabilitation and the need for a rescue pack, but emergencies are handled by NHS 111, 999 and A&E, and plans should be shared with your GP so that one self-management plan is used.