Exacerbations: What Do They Mean?

This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 30, 2020.

Dear COPD Coach,
I’m confused about what having an exacerbation of my COPD really means. Are there any signs or symptoms which my family and I can see that indicate I am having an exacerbation or is this just the same as an infection?

—COPD Exacerbations

Dear Exacerbations,
Knowing the early warning signs of an exacerbation is very important. As we have documented in previous letters, exacerbations are a problem with COPD, especially when you have not quite recovered from a previous exacerbation. And it’s easier to treat an exacerbation in the early stages versus when it is full blown.

First of all, exacerbations are often the result of either a bacterial or viral infection. If you are exposed to harmful pollutants, this can also cause a worsening of your symptoms. The signs to look out for are:


  • Your breathing becomes harder than what is considered normal for you. During an exacerbation you may experience unusual breathing sounds like wheezing. This would indicate that your airways may be partially blocked.
  • Coughing that is more severe than normal. Your cough may be dry (also referred to as non-productive) or you may be bringing up more mucus than normal. If you are bringing up mucus, it will be yellow, green or bloody if an infection is present. You may also experience increased difficulty when lying down.
  • Changes in skin or nail color. A blue tint on your nails or around your lips indicate that you may not be getting enough oxygen. If this happens you should seek help right away! A change in your response to regular breathing medications. For example, if you take a fast-acting reliever medication by inhaler or nebulizer and it always helps you feel “opened up,” but one day it doesn’t seem to help, that is an early warning sign of possible exacerbation.
  • Headaches are often a sign of poor oxygen processing. If you wake up in the morning with a headache, and this is a new symptom for you, it could be a sign that you may be experiencing an exacerbation.
  • Swelling in your ankles and feeling of pressure on your diaphragm or ribs, are common COPD symptoms and are associated with heart complications or results of lung damage. If these symptoms are new to you or appear to be increasing suddenly, it may be a sign of an exacerbation. Note: Talk with your doctor about chest pain and ask when you should seek immediate medical attention, or when the discomfort is not urgent but may be caused by changes in your ribs or chest wall due to COPD.
  • If you feel yourself breathing more from the chest, shoulders, or neck than your abdomen, this can also be a sign of an exacerbation.
  • Increased difficulty sleeping or no desire to eat could also signal an exacerbation.

One doesn’t need all of these signs to denote they are having an exacerbation. What is important to note is that if you are able to notice the early signs of an exacerbation, and get treatment, you may well avoid additional complications and possible hospitalizations!

Best Wishes,
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.


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  • Hi, I would like to add a couple of things I do when experiencing exacerbation onset. I routinely take 400 mg of guaifinesen morning and night. When symptoms begin, I will take this dose every 4 hours. I use a national drug store private label brand for affordability. Additionally I keep prednisone available, and will take 40 to 80 mg depending on the severity of the symptoms. These steps are always taken with an immediately planned trip to a medical specialist to follow. If you have albuterol nebulizer treatments available at home, this treatment should be included as well. Harold B
  • I got influenza and I got it bad, the accompanying symptoms with flue are an exacerbation temperature high and low, its called fever (rigor) We that fight COPD daily know what we need to do in the case of an exacerbation, all doctors should be making sure we have an emergency pack, this consists of two drugs, a cortecosteroid and a antibiotic and they should be left at the COPD sufferers discretion, the decision whether or not to take them not have to go to the surgery for examination like I had to do, then be cross examined by a pharmacist on the phone as why one needs to take them.We have this disease, we need to own it, to remain proactive so the symptomologies do not get worse.Strange doctors who do not know you are always making sure that you need what you ask for, just not good enough, oh how I hate bl..dy doctors who mess with your life.I was not diagnosed asthmatic until life threatening attacks despite my going to the doctors and telling them I had respiratory distress, they have their own ideas about asthma, hello Asthma has caused me to have COPD in later life.I tell you now do not take what any doctor tells you as genuine, if it sounds wrong, then it is wrong, get a second opinion, one cannot pussyfoot about here, one life, its yours, make sure you keep it.Whilst I am on this soap box, to all that carry colds and flue, think on, one sneeze from you (whilst you will undoubtedly get better, it could though be another nail in the coffin for us COPD suffers with compromised lungs and an inability to get better like you do. Jim, listen to Jim, he knows, and has wrote at lenght about the psychological effects COPD has on us, we are not idiots like many doctors seem to think we are, to them especially the one that retired to Surrey who damn near allowed me to die,to him, hello, its our lungs that are affected not our brains.