What Is a COPD Exacerbation?

What is a COPD Exacerbation?

COPD exacerbation, also called a COPD flare-up, is defined as a period of time when COPD symptoms worsen. Because having an exacerbation can lead to disability, hospitalization and even death, it’s important for you to recognize the symptoms of an exacerbation and know what to do if you feel one coming on.

Causes of COPD Exacerbation

The primary cause of COPD exacerbation is bacterial or viral lung infections. Air pollution has also been identified as a precipitating factor. In about one-third of all cases, however, the cause of a COPD exacerbation cannot be identified.[1]

Symptoms of COPD Exacerbation

The earlier you recognize symptoms of a COPD exacerbation, the earlier you can seek treatment which improves your chances of a speedy recovery. If you notice any of the following symptoms, contact your health care provider as soon as possible:[2]

  • Worsening breathlessness
  • Increase in cough
  • A change in the color, consistency or amount of mucus
  • Feeling more tired than usual
  • Inability to carry out normal, daily activities
  • Confusion
  • Excess sleepiness
  • Lower than normal oxygen saturation levels
  • Fever

Treatment of COPD Exacerbation

Most exacerbations can be managed on an outpatient basis. Those that are severe or life-threatening, however, must be managed in a hospital.

There are three types of medications most commonly used for exacerbations. They include:1

  • Bronchodilators – short-acting, inhaled bronchodilators with or without short-acting anticholinergics (another type of bronchodilator) are usually the preferred bronchodilator of choice for treating a COPD exacerbation. These medications can be delivered through a metered-dose inhaler or a nebulizer.
  • Corticosteroids – short-term treatment with oral corticosteroids in the treatment of COPD exacerbation has been found to shorten recovery time, improve lung function and low blood oxygen levels and reduce the length of hospital stay in exacerbation patients. It also reduces the risk of early relapse and treatment failure.
  • Antibiotics – reserved for patients whose exacerbations are caused by bacterial lung infections. Antibiotics are ineffective in the treatment of exacerbations caused by viruses.

Other treatment options include:1

  • Oxygen therapy – supplemental oxygen is one of the key components of treatment in a COPD exacerbation. Oxygen therapy should only be used under the strict advice of your health care provider.
  • Ventilatory support – when oxygen therapy is not enough to sustain a patient’s oxygen saturation level, ventilatory support may be necessary. This can be accomplished through non-invasive mechanical ventilation (CPAP or BiPAP) or mechanical ventilation whereby a tube is inserted down the windpipe and attached to a breathing machine. When mechanical ventilation is necessary, patients must be hospitalized.

Factors Associated with More Frequent Exacerbations

Studies have found the following factors to be associated with more frequent exacerbations:[3]

  • Previous hospitalization for COPD exacerbation
  • Increased age
  • Low forced expiratory volume in one second (FEV1)
  • Increased breathlessness
  • Low body mass index (BMI)
  • Continued smoking
  • Chronic (long-term) hypersecretion of mucus
  • The presence of other significant illnesses
  • Poor exercise capacity

Prevention of COPD Exacerbation

Oftentimes, a COPD exacerbation can be prevented. The following preventive strategies may help:

  • Smoking cessation is the single most important intervention in treating COPD and COPD exacerbation. Not only does quitting reduce your risk of COPD exacerbation, but it helps prevent worsening lung function characteristic of COPD.
  • Get vaccinated with a pneumonia vaccine (if your doctor says you need one) and an annual flu shot. Flu shots can reduce the risk of serious illness and death in COPD by as much as 50 percent.
  • Practice proper handwashing. Handwashing is one of the most important ways to prevent the spread of germs that may cause a COPD exacerbation. Be sure to scrub your hands, wrists and fingers thoroughly with soap and warm water for at least 20 seconds.
  • Know how to use your nebulizers and inhalers properly. Improper use of nebulizers and inhalers may increase your risk for COPD exacerbation. Ask for a demonstration the next time you visit your doctor’s office.
  • Avoid environmental irritants such as secondhand smoke and air pollution. Clean up your indoor air. Pay attention to air quality reports and stay indoors when air quality is poor.
  • Stay away from crowds and people who are sick, especially during cold and flu season. Exposure to germs from sick people can increase your risk of COPD exacerbation.
  • Increase your knowledge of current drug therapies. Long-acting, inhaled bronchodilators with or without inhaled corticosteroids and treatment with phosphodiesterase-4 inhibitors (a newer class of COPD medication) are treatments that have been found to reduce the number of exacerbations and hospitalizations in COPD.


[1] Global Strategy for the Diagnosis, Management and Prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Updated 2016.

[2] Exacerbation of COPD. American Thoracic Society. Patient Information Series. Accessed 4/14/2016.

[3] Scott D. Ramsey and F. D. Richard Hobbs “Chronic Obstructive Pulmonary Disease, Risk Factors, and Outcome Trials”, Proceedings of the American Thoracic Society, Vol. 3, No. 7 (2006), pp. 635-640.

By Deborah Leader RN, BSN, PHN


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