COPD (chronic obstructive pulmonary disease)

Managing COPD flare-ups

A flare-up – sometimes called an acute exacerbation of COPD – is when your COPD symptoms (cough, sputum and breathlessness) become worse than normal day to day.

Call 999 if you’re struggling to breathe or have sudden shortness of breath and:

  • your chest feels tight or heavy
  • you have a pain that spreads to your arms, back, neck and jaw
  • you feel or are being sick

You need to be seen urgently.

Signs of a flare-up are:

  • your breathlessness gets worse and this goes on for some time without getting better
  • you cough more
  • you produce more sputum
  • there’s a change in the colour and consistency of your sputum

A flare-up might be triggered by an infection or there may be no apparent reason. Watch out for changes in your chest symptoms if you get a cold.

You should have a plan that you’ve agreed with your health care professional so you know what to do if this happens. Take a look at our checklist below.

If your breathlessness gets worse, but you have no fever and your sputum is normal for you, the first step is usually to use your reliever inhaler more. Make sure you know how to make changes – such as increasing the dose or how to take your bronchodilator medicine – to help with your symptoms. Many milder flare-ups will respond to this.

If your symptoms pass and don’t develop into a flare-up, remember to tell your health care professional about your experience.

Your flare-up plan may include a rescue pack of drugs (antibiotics or steroid tablets or both) that you keep at home. To be certain that you have a flare-up that needs this medication, it’s usual to start rescue drugs after using your reliever medication for a day or two. But you must discuss your particular situation with your health care professional.

Make sure you know when:

  • you should start to take steroid tablets. These help you to get better more quickly, but it’s important not to use these too frequently, because of potential long-term side effects. 
  • you should start to take antibiotics. This will usually be when, as well as being more breathless despite taking reliever medication for some time, you produce more sputum than usual or it has changed colour.

Let your doctor or nurse know

  • if you take your rescue pack medication
  • if things don’t improve within 2 days of starting the rescue pack.

Most people can be treated at home if they have a flare-up, but you may need to go to hospital depending on how severe your symptoms are. If you use the ambulance service, make sure to say you have COPD, so you get the right oxygen treatment.

It usually takes a few weeks or even months to feel completely back to normal after a flare-up.

Stopping smoking

If you’re a smoker, stopping smoking will help you to live longer but can also reduce or stop flare-ups completely.

Multiple flare-ups

If you have more than 3 flare-ups in 1 year that require your rescue drugs, get a review with your GP or nurse. It may be a good idea to get samples of your sputum analysed to see if you have an unusual or resistant infection. These can include pseudomonas and atypical mycobacterial infections, such as non-tuberculous mycobacterial infection (NTM).

Your doctor may order a scan of your chest to see if there is an area of damaged lung that makes you more susceptible to infections.

If you are susceptible to these infections, make sure you act very quickly when you have a flare-up and be aware your usual rescue drugs may not be effective. Sometimes people who have frequent chest infections benefit from taking regular antibiotics. This is usually started by specialist teams.

Your flare-up checklist

COPD flare up

Hospital at home schemes

Most people with COPD who have a flare-up do not need to be admitted to hospital and can stay at home. But in some areas of the country, people who would be admitted to hospital elsewhere, can also be treated at home. These local hospital at home schemes provide medication and visits by a specialist team. This means you can recover at home where you might feel more comfortable and can be more active when you feel ready. If you would prefer to be treated at home, speak to your doctor or nurse.

If you have concerns or need advice, call our helpline on 03000 030 555 between 9am and 5pm on a weekday or email them.

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Last medically reviewed: September 2019. Due for review: September 2022

This information uses the best available medical evidence and was produced with the support of people living with lung conditions. Find out how we produce our information. If you’d like to see our references get in touch.