What is a COPD Exacerbation?

This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on February 4, 2020.

Dear COPD Coach,
I was recently diagnosed as having COPD. The doctor who diagnosed me said that my condition is still not very severe, but could get worse if I were to start having exacerbations. I understood him to mean that an exacerbation means time that I would end up in the hospital because of not being able to breathe. What exactly is an exacerbation and how do you avoid having one?

—Newly Diagnosed

Dear Newly Diagnosed,

An exacerbation is when there is an increase in the severity of the symptoms of a chronic disease.

The main symptoms of a COPD exacerbation are an increase in breathlessness which can also be accompanied by these additional symptoms: increased wheezing, a tightness in your chest or soreness when breathing, increased mucous production with a change in its color (usually a darker yellow or green) or thickness, and a fever. Oftentimes, severe exacerbations may result in pneumonia. Each time a person with COPD gets an exacerbation, lung damage can occur, and it is quite possible that some or all of the damage can be permanent. Repeated exacerbations can accelerate the progression of COPD. The two most common causes for a COPD exacerbation are viral or bacterial lung infections or exposure to pollutants.

Treatments for an exacerbation might include supplemental oxygen, antibiotics, corticosteroids, bronchodilators or in the case of a major exacerbation, ventilation either by a mask or a tube inserted into the windpipe. Exacerbations are the most common cause for a person with COPD to be admitted to a hospital.

It should be fairly obvious that having COPD and experiencing an exacerbation is not a good thing! While a tendency towards some type of exacerbation is pretty likely, we can take measures to avoid getting one, or at least minimizing the severity of the exacerbation by following some commonsense steps:

  • Take your medicines as prescribed – make sure you’re taking inhaled medications correctly by showing a respiratory therapist your technique.
  • Avoid irritants, especially secondhand smoke, chemicals, fumes, or dust.
  • Remain as active as your condition will safely allow (Pulmonary Rehabilitation is a big help).
  • Avoid exposure to people who are sick.
  • Wash your hands frequently with anti-bacterial soap, especially after exposure to illness. Also consider wearing a mask when out, especially during flu season.
  • Keep your flu and pneumonia vaccinations up to date.
  • Maintain a healthy diet.
  • Take extraordinarily good care of yourself!

The best tool for limiting the severity of an exacerbation is recognizing the early signs (outlined above) and immediately seeking medical help. Too often, people with COPD try to self-manage their care (taking over-the-counter medications) or simply deny their symptoms. Immediate treatment can often reduce or eliminate the need for hospitalization and minimize resulting lung damage.

It is possible to avoid most exacerbations – or at least help them be less serious. Learning how to do this will play a large part in helping you have your best possible quality of life.

Review the COPD FOundation Avoiding COPD Exacerbations page to learn more.

I hope this helps.

–The COPD Coach

Coaches Corner is aimed at providing information for individuals with COPD to take to your doctor, and is not in any way intended to be medical advice. If you would like to submit a question to the Coaches Corner email us at coachescorner@copdfoundation.org. We would love to hear your questions and comments. You can address your emails to The COPD Coach.


You need to login to comment.
  • The most important thing is to get to your doc ASAP. I usually find that women "don't want to bother" their doc and guys think they can "tough it out". Both are quick ways to a hospital bed. What's an annoying cold to your kid or spouse can put you in the hospital, so teach those folks to practice good hygiene and don't bring bugs home! If you do get something get to your doc ASAP. One of my good doc friends, Dr. Brian Tiep, says, "Think of an exacerbation as a party and make sure I get the very first invitation!" You doc would much prefer to work with you over the phone, via email or even in his office rather than see you in the hospital.

    • Thank you Jean just got out of hospital 3 wks ago pneumonia. I'm already getting suck after weaning off of steroids
  • I am a frequent flyer at the hospital with pneumonia and the beginnings of Sepsis. Four times I have done this and the last was a COPD exacerbation while at Pulmonary Rehab next door to the hospital. I was exercising and all of a sudden I started shivering and could not stop and then I felt the air going away and I had left my tank in the car. Thankfully my wife was with me and she got me to the car and on the tank but then had to drive what seemed like an eternity to Emergency where they took me right back and got me some treatment before waiting 3 or 4 hours for a hospital bed to be ready. Even with my tank putting out 5 liters Conserve (I should have had it Continuous) I just could not breathe and for a short time thought I was a goner. Definitely a scary thing to have.
  • One of the things that is really important for people with COPD to be able to do is know what the fed flags are so that we can catch exacerbations before they become bad enough to put us in the hospital. I'm curious whether you can think back on what happened in the days prior to your having that experience at rehab to see if there were things that might have tipped our off that something wasn't quite right. If there were, then you know what to look for and be careful about in the future. If not, I'd talk with your doc about it because that's pretty scary and maybe there are things you can do or take that will help avoid such situations in the future.

    • Sorry, I should have said that these hospitalizations have happened over the past 5 years with the excaberation being in April 2019. Jean what was so surprising was that it happened out of the blue. I had been doing treadmill work and just finished a half hour on the Nu Step and was getting ready to leave when the chills hit. The first time I had the pneumonia and developing sepsis was in November 2015 and it hit while I was watching TV - just started shivering and could not stop. I haven't been in the hospital yet this year but in January I had a major change in oxygen need - went from 2 liters at night and 2 liters when working in the day (3 lpm when exercising) to an almost immediate 3 LPM at night and 3LPM all day for just sitting and reading or 4 liters for doing any walking at all. So I did go to the doctor and just finished up a whole series of tests which turned into the same diagnosis as before - mild COPD but with Covid19 around, I am having trouble getting appointments with the Lung Clinic. Soooooo just keep pumping in the ox. Fired up a band new Invacare Concentrator today to augment the same thing in my bedroom. This one is on the other side of the house and I have to pay for it - not Uncle Medic Care....LOL