What is a COPD exacerbation?

What causes the worsening of COPD symptoms?


COPD or Chronic obstructive pulmonary disease is a group of lung conditions made up of two conditions called chronic bronchitis and emphysema, ultimately resulting in breathing difficulties. COPD results in the narrowing of the air sacs and inflammation of the airways which makes it difficult for the air to empty out of the lungs. COPD patients are at risk of experiencing exacerbations or “flare ups” which is an episode of worsening symptoms of COPD. 


A flare up of COPD symptoms such as coughing or shortness of breath is called an exacerbation of symptoms. In most cases, an exacerbation is due to an infection of the lungs, but the cause is not always known. The exacerbation of the lungs causes inflammation and hence irritation and swelling of the lungs leading to COPD patients falling extremely ill. The timeframe to recover from a COPD exacerbation can vary, with some lasting days to others lasting months.

Most commonly, it is a viral infection of the lungs that can trigger a COPD flare up, but it can also be bacterial or fungal in nature. An infection is not necessarily needed to trigger a flare up. Inhaling substances from the environment that can irritate the airways like pollution or allergens might also be a cause of a COPD exacerbation. The lungs become inflamed from the irritants or infection and cause the airways to narrow further due to the tightening of muscles, swelling of the airway and build up of mucus. These changes result in the worsening symptoms of COPD. 

Symptoms of a COPD exacerbation

COPD flare ups can develop very rapidly, within hours to days. The symptoms of an exacerbation are similar to COPD symptoms, just exaggeratedly worse. You might notice these:

  • Worsening shortness of breath on physical exertion (eg like walking or climbing the stairs)
  • You might cough more frequently or it may increase in severity 
  • You might develop a new cough altogether
  • You might notice a change in your sputum colour, or start bringing up coloured mucus or notice an increase in sputum production
  • You might feel more tired than normal
  • You might struggle to sleep 
  • Drop in oxygen saturation

If the exacerbation is due to an infective cause you might also experience:

  • A fever 
  • Confusion 

If you have experienced a COPD exacerbation in the past, you might notice a pattern of your symptoms. 


A COPD exacerbation diagnosis is usually a clinical diagnosis. A doctor will take a detailed history of your symptoms, allowing them to get a better understanding of how your COPD symptoms worsened. They will usually proceed to do an examination of your chest, listening to your breathing and lung fields. If necessary, they might request some tests like a chest X-ray, blood tests and sputum culture. Catching a COPD exacerbation early is the best way of preventing it from escalating in severity. 


Depending on the severity of the exacerbation, treatment will differ. Some exacerbations (mainly mild ones) can be treated at home, without a hospital stay, with inhalers like Trimbow and Fostair, steroids with or without antibiotics. The steroids aim to control the airway swelling, the inhalers treat the airway constriction and antibiotics to fight the infection of the lungs. Some patients might need to stay in the hospital to receive oxygen therapy. As the lungs play a key role in the oxygen supply to the body, exacerbations interfere with the gas exchange occurring in the lungs. Some patients might need a little extra oxygen using a face mask or nasal cannula. In some severe cases of COPD exacerbation, some patients might need to be transferred to the intensive care unit for mechanical ventilation (where a machine breathes for you). 

Should I be worried?

COPD exacerbation varies in severity, however, it can be very serious and lead to death. Early medical intervention is very important to help treat the exacerbation. It is difficult to predict when or if you will experience a COPD exacerbation. If you have experienced an exacerbation in the past, the likelihood of having another exacerbation is elevated. It is important to keep an eye out to see if your COPD symptoms worsen at any point. 


While not all exacerbations can be avoided, there are steps you can take to decrease your chances of getting a flare up, how often you experience a flare up and how severe they become. Here are some steps you can take:

  • If you still smoke, take steps to quit. 
  • Avoid spending time with people who have colds or flu are you are at risk of catching it 
  • Practice good hand hygiene to avoid contracting infections 
  • Take your flu vaccine every year
  • Take your COPD medication as prescribed by your doctor 

If you need help to stop smoking, Dr Felix offers Champix, a smoking cessation medication. Champix is a nicotine free medication that can help you manage the withdrawal effects and cravings you might have for nicotine when stopping smoking.

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