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 room 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 healthcare 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.

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 healthcare 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 six seconds.
  3. Add a “0” to the end of that number. This equals the number of times your heart is beating each 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:

  • Wash your hands often. This will help prevent infections.
  • Avoid close contact with people who have colds or the flu.
  • Get a flu shot each year.
  • Ask your healthcare provider about a pneumonia (new-moan-ya) shot.
  • Always take your controller/maintenance medicines as prescribed by your healthcare provider.
  • Use antibiotics as soon as possible for infections or sinus problems.
  • Work out a COPD action plan with your healthcare provider.

Things NOT to do during an exacerbation

  • Do not take extra doses of theophylline (thee-oh-fi-leen).
  • Do not take codeine or any type of cough suppressant (sue-press-ant).
  • Do not use over-the-counter nasal sprays for more than three days.
  • Do not smoke.
  • Do not wait more than 24 hours to call your healthcare provider if your symptoms continue.

Have a Plan for Avoiding and Treating Exacerbations

You and your healthcare 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 healthcare provider, go to the emergency room, and be admitted to the hospital.

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

Show your healthcare 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’s website 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!


What is Pneumonia?

Pneumonia is an infection of one or both lungs. Organisms settle in the air sacs where they grow rapidly. These air sacs become filled with pus and fluid as the body attempts to fight infection. Young children, cigarette smokers, adults over 65 and people with certain medical problems including COPD are at greater risk for developing pneumonia. COPD is the third leading cause of death, while pneumonia and flu contribute to the eighth leading cause of death in the United States.

What causes Pneumonia?

Pneumonia is most commonly caused by bacteria, viruses and less commonly fungi which are more common in patients with suppressed immune systems. Contact with the organisms occurs either through directly touching objects with your hands (which then transmit the organism to your mouth, nose or eyes), or through inhalation of droplets containing the organisms. The causes of pneumonia for which vaccines (shots) are available include:

  • Influenza (Flu)
  • Pneumococcus
  • Measles
  • Pertussis (whooping cough)
  • Haemophilus influenzae type b (Hib)

Symptoms of pneumonia:

There are several symptoms of pneumonia that are similar to those of a COPD flare-up, which are often caused by infection. It is important to recognize these pneumonia symptoms and to call your doctor if you experience one or more of the following:

  • Fever over 100.5 degrees or shaking chills
  • Shortness of breath or more rapid breathing
  • Nausea, vomiting or diarrhea
  • Cough with increased amount of mucus
  • Cough with a change in mucus color
  • More rapid heart rate
  • Pain in one area of the chest with deep breaths

How can I avoid Pneumonia?

  • See your health care professional at your regularly scheduled appointment even if you feel fine
  • Get your flu shot every year. Local pharmacies and grocery stores offer these shots at the start of flu season
  • Check if you are due for a pneumonia shot which can greatly reduce your risk of developing pneumonia
  • Wash your hands often and carry a small bottle of hand sanitizer for when you cannot wash your hands
  • Avoid touching your mouth, eyes, and nose in public to help prevent germs from entering your body
  • Stay away from crowds, especially during cold and flu season
  • Use your own pen, especially when signing in at your doctor’s office or other health care appointments
  • Don’t smoke as it makes it harder for the lungs to fight off an infection
  • Get plenty of sleep. When your body is tired, you're more likely to get sick

It is possible to stay healthy, even if you have COPD, at any stage. Watch for early warning signs of COPD flare-ups which may include pneumonia and report them right away. Work with your health care team to avoid pneumonia!


Download the Exacerbation and Pneumonia Fact Sheets


Resources and Support

The COPD Foundation offers resources such as COPD360social, an online community where you can connect with patients, caregivers and healthcare providers and ask questions, share your experiences and receive and provide support. We also offer free, downloadable educational materials available through our downloads library.


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