Coping With COPD Flare-Ups

Last updated: October 2022

61% of respondents indicated in the 2018 In America survey that they want information on coping with COPD flare-ups. Kevin shares information on how he handles and avoids flare-ups from a patient perspective.

If nothing else besides being extremely frightening, flare-ups are extremely frustrating (for me anyway).

You could be going along, right as rain (well as much as anyone with COPD can be described as “going along”) and wake up one morning and find that, among other elements, your ability to breathe has changed dramatically.

But first, maybe we’d better describe what an exacerbation - a flare-up - feels like or looks like coming down the road.


COPD symptoms are unique to each of us to begin with so, it’s up to us to recognize what’s going on with our bodies - how you feel on a typical day, how your breathing feels, how much you cough.

Pay close attention when things feel like they’ve changed or are changing.

WebMD suggests being aware of the following:1


A sudden increase in SOB (shortness of breath), particularly in situations that were previously manageable, oxygen-wise, is a good indication that a flare-up may be on its way.

A friend of mine told me he was brushing his teeth - something he never had trouble with despite the COPD - and suddenly felt like he was going to collapse.

You feel like you have to use your chest muscles to breathe instead of your diaphragm.

Your breathing becomes more uneven than usual and, sometimes, your chest moves a lot faster or, in some cases (see above “unique”) sometimes it’s much slower.

Or even at rest, you might find yourself gasping for air.


You may be having a terrific day and suddenly find yourself having to cough much more than you have been and when you do, there’s twice as much phlegm.

And then, sometimes you hear odd noises as you breathe. Your breathing begins to make strange noises.


This suggests mucus or pus is blocking your airways.2 Gurgling could mean fluid in your lungs.

Your appearance

There might be changes in your skin or nail color. You see a bluish tint around your lips. Your skin looks yellow or gray.

Early-morning headaches

You start the day with a throbbing head because of a buildup of carbon dioxide in your blood.


For me, the hardest part about flare-ups (exacerbations) IMHO, is their unpredictability. They show up when you least expect them. But after a while, when it happens, you’re not so surprised anymore.

In my case I get disappointed (I was getting around pretty good there for a while, wasn’t I?) and a little frightened (Is this the Big One?).

But, I’ve been fortunate. I haven't had that many flare-ups since I was diagnosed (2011), so, I've been relatively lucky compared to what I've heard from others.

John, my buddy from high school in Brooklyn, who I’ve known for more than 40 years, tells me this about his experience with flare-ups:

“When they come, I use a long-acting bronchodilator and a rescue inhaler, but the cold weather is no friend of anyone with COPD (emphysema, chronic bronchitis). Cold air thickens the mucus and makes coughing that much more difficult. Last year was the worst I've experienced with SOB and congestion. I coughed so violently I briefly passed out. At the ER, I was given nebulizer treatments of Albuterol and Atrovent. I had some relief but needed steroids to lessen the inflammation,” John told me.

Or maybe your symptoms are nothing like these and are their own unique set that no was else has. And since the symptoms are so incredibly unique at times, the duration and possible treatment are that much more unique.

“I began to feel better and could breathe again without much constriction,” John added, “I have been paying much closer attention to my symptoms since then to avoid a repeat.”


Infections cause 75% or more of the exacerbations. Airway inflammation becomes increased which can result in increased hyperinflation, and decreased gas exchange.3,4

As COPD progresses, exacerbations tend to become more frequent, averaging about three episodes per year.5

That’s about where I’m at.’s own John Bottrell had a terrific piece on flare-ups back in April of this year.

I recommend reading it - especially the part about creating a COPD Action/ Management Plan. These are plans printed on a single sheet of paper. They are put in an easy to find place, like the refrigerator door. They can help you decide what actions to take when you experience symptoms. One action may be to call your doctor. Another may be to call 911. You can view a sample plan here.

How to avoid flare-ups

Of course, if possible, and I know it’s not easy, the best thing that can happen is to try to avoid as flare-ups in the first place.

Much of what I’ve read about Exacerbations/Flare-up recommend similar approaches to avoid them or fighting them once it happens.

The first thing is to schedule and keep regular appointments with your doctor, even if you’re feeling perfectly fine at the time.

Get your flu shot every year. I get mine at CVS when I’m picking up a prescription. Walgreens, Right-Aid - almost all pharmacies offer them these days.

Wash your hands often with warm water and mild soap and use hand sanitizer. I try to be particularly conscious of this in my pulmonary work-out center, especially around now when everyone is coughing and sneezing (including me!).

The staff at my center insist we all wipe down “hand-holds” on the equipment we’ve used as soon as we’re finished using it - you should make sure yours does too.

Drink liquids and stay hydrated.

Take sleep time seriously. When your body is tired, you’re more likely to get sick. That tip, as I’ve written before, is one that is easily done by me!

Please remember, if you or a loved one with COPD are showing symptoms of a flare-up, please remember to call your doctor at once or, if necessary, get yourself to an ER - ASAP!

By providing your email address, you are agreeing to our privacy policy.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Join the conversation

Please read our rules before commenting.

Community Poll

Who is treating your COPD?