What is an Exacerbation?

An exacerbation (x-saa-cer-bay-shun) of COPD is a flare-up or episode when your breathing gets worse than usual and you become sick. With COPD you may have no symptoms, or stable symptoms, for a long time. Then suddenly you may have a flare-up, often caused by a lung infection. This can be very serious, causing you to go to the emergency department or stay in the hospital overnight. Many times exacerbations can be prevented or at least be less serious. That’s why an important part of managing your COPD is learning how to watch for changes, and knowing what to do next. In doing this, you will be more likely to keep your COPD stable and stay out of the hospital.


Is it an Exacerbation or Just a Bad Day?

The first step in recognizing an exacerbation is watching for changes in your symptoms. The quicker you know you are starting to have problems, the quicker you and your health care provider can deal with it.

Being able to tell the difference between a “bad day” and an oncoming exacerbation is not always easy, but it is important. Some things that might cause you to have a bad day are: weather, barometric changes, emotions, allergies, higher altitude, and using an empty inhaler. A true exacerbation or flare-up is much worse than just a bad day.

Early Warning Signs of Exacerbation

Warning signs that a flare-up is happening or about to happen are different for each person. Most of the time, you will know best when your breathing problems are getting worse. But sometimes, some signs of a problem will be noticed by your friends and family first. Make sure your friends and family are aware of the signs below.

Important Early Warning Signs are:

  • Increases in cough.
  • Sputum production.
  • Shortness of breath which is more than usual.

The most common signs and symptoms of an oncoming exacerbation are:

  • Low grade fever that doesn’t go away.
  • Increased use of rescue medications.
  • Change in color, thickness, odor, or amount of mucus.
  • Tiredness that lasts more than one day.
  • New or increased ankle swelling.
  • More wheezing, coughing, or shortness of breath than usual.

In addition, an exacerbation may come with:

  • More morning headaches, dizzy spells, and restlessness.
  • A need to increase your oxygen, if you are on oxygen.
  • Rapid breathing.
  • Rapid heart rate.

Call 911 for Dangerous Warning Signs

  1. Confusion, disorientation, or slurring of speech.
  2. Severe shortness of breath or chest pain.
  3. Blue color in lips or fingers.

What Causes an Exacerbation?

An infection in your lungs is almost always the cause of an exacerbation. These infections may be caused by viruses or bacteria. Antibiotics (an-tee-by-ah-ticks) are medicines that can be given for an infection caused by bacteria. These drugs do not help with infections caused by viruses.

Many times, when a person with COPD gets an infection from a virus, they also get a second infection from bacteria. This happens because the virus has caused more mucus to be made, which has irritated the lungs. Together, this causes more bacteria to grow in the lungs. This can lead to a bacterial infection.

So, antibiotics are almost always used to treat serious exacerbations. Other causes of exacerbations include: sinus infections, indoor and outdoor air pollution, pulmonary edema, and blood clots to the lungs.

Know Your Heart Rate and Rate of Your Breathing

As a person with COPD, it is important that you know what your heart and breathing rates are when you are feeling good. These are called your "baseline" rates.

When you start to feel a flare-up coming on, take your heart rate and breathing rate. Compare these to the baseline rates.

Knowing if your breathing and heart rates have increased will help you talk to your doctor about your flare-up. Your health care providers will use this information to help decide how to treat your exacerbation.

Counting Your Respirations (Breathing Rate) for One Minute:

  1. Place your hand on your upper chest to feel it rise and fall. Each rise and fall counts as one "respiration."
  2. Look at your watch. Count the number of respirations in 30 seconds. Multiply this number by two.

Counting Your Heart Rate for One Minute:

  1. Find the heartbeat, or pulse, in your neck. Put your index and middle fingers to the side of your throat, under your chin. Don’t press too hard. Don’t rub.
  2. Look at your watch. Count your heartbeat for 10 seconds, then multiply by 6. This is your heartbeat in one minute.

Try to Reduce How Often You Have Exacerbations and How Serious They Are

You cannot prevent exacerbations entirely, but you can reduce how often you have them. You can also reduce how serious they are if you work to stay as healthy as possible.

Tips for reducing exacerbations:

  • Handwashing is key. Make sure you follow best practices for handwashing at https://www.cdc.gov/handwashing/when-how-handwashing.html
  • Avoid close contact with people who have colds or were diagnosed with respiratory infections like the flu or coronavirus.
  • Get a flu shot each year.
  • Ask your health care provider about a pneumonia (new-moan-ya) shot.
  • Always take your controller/maintenance medicines as prescribed by your health care provider.
  • Use antibiotics for bacterial exacerbations as prescribed by your health care provider.
  • Work out a COPD action plan with your health care provider.

Things NOT to do during an exacerbation

  • Do not take codeine or any type of cough suppressant (sue-press-ant).
  • Do not smoke.
  • Do not wait more than 24 hours to call your health care provider if your symptoms continue.

Have a Plan for Avoiding and Treating Exacerbations

You and your health care provider can create a written plan for preventing exacerbations. You should also have a plan for treating exacerbations early on, before they get so serious. This plan may include adding to, or changing, the medicines you normally take. If you are not using an inhaled steroid, you may need to during the exacerbation. You may also need to use supplemental oxygen.

If you have a written plan, you may be able to deal with your exacerbation at home. But there may be times when you will need to see your health care provider, go to the emergency department, and be admitted to the hospital.

Sometimes it can be hard to know when to contact your health care provider or when to go to the hospital.

Show your health care provider the My COPD Action Plan and ask if you can work together to avoid and treat exacerbations.

Air Quality in Your Home

The air you breathe can have a big impact on your health, and indoor air can sometimes be more polluted than outdoor air.

According to the Asthma and Allergy Foundation of America, there are 3 major airborne threats in a home: allergens, irritants, and dangerous chemicals.

Allergens come from pollen, dust mites, and pets, and can cause your immune system to react.

Irritants won’t necessarily trigger your immune system, but can include compounds that can make breathing more difficult. Common indoor air irritants include chemicals used in painting, finishing, or staining furniture. Pesticides, tobacco smoke, and chemicals in cleaning products are irritants as well. Sometimes these chemicals have odors that you can detect but sometimes they don’t.

Take these steps to purify the air in your home:

  1. Ventilate your home by opening windows and running exhaust fans
  2. Do not allow smoking in your home
  3. Remove clutter (clutter collects dust!)
  4. Minimize dust mites by washing your bed linens weekly, lowering the humidity level, and keeping pets off your furniture
  5. Keep floors and carpets clean
  6. Install an air filtration system
  7. Have your air conditioner inspected regularly for mold and mildew in the duct work
  8. Reduce your exposure to household chemicals such as paints, varnishes, and cleaning products

Visit the Asthma and Allergy Foundation of America for more tips on how to improve the air quality of your home.

It is possible to stay well, even if you have COPD, at any stage. Watch for early warning signs and don’t ignore them. Work with your health care team to avoid acute exacerbations!


Resources and Support

The COPD Foundation offers resources such as COPD360social, an online community where you can connect with patients, caregivers and health care providers and ask questions, share your experiences and receive and provide support.