Chronic obstructive pulmonary disease (COPD) flare-ups can happen at any time. Learn six signs of COPD exacerbation and what to do.

Published: November 22, 2022 | Updated: February 12, 2024

Chronic obstructive pulmonary disease (COPD) refers to disorders that cause airflow blockage and breathing-related issues. The classic symptoms of COPD include wheezing, coughing, shortness of breath and trouble taking deep breaths. The signs of COPD getting worse could mean you are having a COPD exacerbation.

A COPD exacerbation is sometimes called a flare-up. When symptoms of COPD become worse quickly, it might be an exacerbation. Exacerbations may be triggered by severe allergies, a common cold or a sinus infection.

“If your symptoms become severe, even for a short time, it’s a good idea to tell your health care provider as soon as possible,” said Josephine Mei, M.D., pulmonologist with Norton Pulmonary Specialists.

6 signs COPD is getting worse

1. Shortness of breath: Of course COPD includes difficulty breathing, but if you are having shortness of breath after climbing stairs or walking up a gentle incline, that is a potential cause for concern.
2. Wheezing: Inflammation causes narrowing of the airway and can cause wheezing. Not everyone with COPD wheezes, but a study suggested that wheezing is typical in more severe COPD symptoms, more frequent exacerbations and decreased lung function. “Wheezing that comes on quickly or stays constant is a sign to seek medical attention,” Dr. Mei said.
3. Changes in mucus: Mucus, also called sputum or phlegm, is the sticky material that lines your nose, lungs and sinuses. When you cough or sneeze, you may spit out some of this mucus. The color of the mucus you produce is important.
   “Typically, we see clear or slightly cloudy sputum, but during an exacerbation, it may turn yellow or even green,” Dr. Mei said. “That could mean an infection in the lungs.”
4. Changes in cough: Coughing is a typical symptom of COPD, but a cough that gets worse or persists for several weeks — or if it is accompanied by chest pain — should be investigated by your health care provider.
5. Fatigue: “Feeling tired or worn out is a common symptom of COPD, because your body has to work harder to get oxygen to the cells,” Dr. Mei said. If you’re feeling extra worn out or fatigued, it is wise to call the doctor. You also may be groggy in the morning as a result of a lack of oxygen or sleep apnea.
6. Swelling: Also known as edema, swelling occurs in the legs, ankles and feet.
   “You can gain anywhere from 5 to 15 pounds from the fluid retained,” Dr. Mei said.
   Other conditions such as pulmonary hypertension and congestive heart failure may contribute to swelling.

How to prevent COPD flare-ups

“Stopping smoking is the most important step if you have COPD,” Dr. Mei said. “That includes staying away from other people who are smoking.” Dr. Mei also advises monitoring weather alerts so you can reduce exposure to the outdoors on poor air quality days.

Some genetic reasons contribute to developing COPD. Be sure to give your health care provider a full health history, in case those genetic conditions can be caught early and possibly slow or stop the onset of COPD.

You also should stay current on your vaccinations such as flu, pneumonia and COVID-19. Talk to your health care provider about medications and exercise programs that can help you stay healthier longer.