10 Warning Signs of COPD Getting Worse

signs of copd getting worseA COPD exacerbation is defined as a period of time when your usual COPD symptoms worsen. For some people, a COPD exacerbation can become so serious that hospitalization is necessary. The most common cause of COPD exacerbations are viral and bacterial infections and air pollution.

Having a flare-up of your COPD symptoms can be downright scary. That’s why, in 5 Ways to Prevent COPD Exacerbation we shared some important tips on how to nip exacerbations in the bud before they occur. How do you know if you’re having an exacerbation? Thankfully, there are 10 warning signs and symptoms that should alert you to seek emergency care or contact your physician as soon as possible.

Early Recognition of Worsening Symptoms

According to the Cleveland Clinic, getting help for an exacerbation as soon as you notice symptoms is paramount to a speedy recovery. Waiting too long could lead to serious complications; possibly even death. Even if you don’t feel sick or you don’t think your symptoms are that bad, ignoring them could be life-threatening.

When to Seek Emergency Care

Sometimes, a COPD exacerbation requires immediate emergency treatment. Go to the closest emergency room or call 911 if you experience:

When to Seek Non-Emergent Care

Many times, a COPD exacerbation can be effectively managed at home, under the care of your physician. However, there are times that you will need to alert your doctor to changes in your condition that could indicate that your COPD is worsening. Keep careful track of your symptoms and note anything that is new or that seems to be more severe. Report any of the following warning signs to your physician within 24 hours:

    1. Worsening shortness of breath
      Shortness of breath is typical with COPD, but shortness of breath that has worsened or occurs more frequently than usual is one of the hallmark symptoms of COPD exacerbation. Contact your physician if:

      • You’re unable to walk as far as you normally do
      • You’re breathlessness causes you to sit upright or prop yourself up on pillows while sleeping
      • The work of breathing tires you out
      • You need to use your rescue inhaler or do breathing treatments more often
      • Shortness of breath awakens you from sleep more than once during the night
    2. Changes in mucus production
      Many people with COPD experience an increase in mucus production as part of their everyday COPD symptoms. When mucus production changes, however, or you see changes in the quality of your mucus, it could mean you’re facing a COPD exacerbation. The following changes in mucus production warrant a phone call to your physician:

      • Changes in the amount, color or consistency (thickness)
      • The presence of odor or blood
    3. Worsening cough
      It can be hard to decide what constitutes a worsening cough. Generally speaking, if you feel your cough is not improving or has taken a turn for the worse, trust yourself and contact your doctor. Additionally, if you experience any of the following with your cough, contact your physician: 

      • It continues beyond four weeks
      • It starts to increase in intensity, depth or frequency
      • It causes you to feel faint or lightheaded 
      • It makes it too difficult to sleep 
      • You struggle to catch your breath regularly while coughing
    4. Increased wheezing
      Wheezing is a high-pitched whistling sound that occurs when you breathe in or out. Any inflammation, spasms or narrowing of your airways can cause wheezing. If you have COPD, you know what the typical amount of wheezing is for you. If you experience more wheezing than usual, or any of the following with your wheezing, contact your physician:

      • Increased shortness of breath
      • Increased difficulty breathing
      • Faster breathing
    5. Frequent morning headaches or dizziness
      Regularly waking up with headaches or feeling dizzy upon waking generally indicates a buildup of carbon dioxide in your blood. If this is a new symptom, or it is happening more often than normal, contact your physician.
    6. Fever, especially if it’s accompanied by cold or flu-like symptoms
      Fever indicates an infection, possibly in your lungs. Though it could just be a sign of a respiratory infection, those can progress quickly for people with COPD. A fever could also be a sign of COPD progression or a COPD flare-up. If you have a low grade fever, between 100℉ and 101℉, it is a good idea to let your doctor know, just so they can advise you on whether or not to treat the fever. If you have a high grade fever, generally anything over 101℉, you will likely need to treat it, so call your physician to find out the best course of treatment for you.
    7. Extreme fatigue or weakness that doesn’t go away after one day
      Any increase in fatigue or weakness should be reported to your doctor, as it likely indicates progression of your disease or a COPD flare-up. However, if that fatigue becomes severe and continues beyond 24 hours, contact your physician.
    8. Unplanned weight loss or weight gain of 2 pounds in one day or 5 pounds in one week
      This kind of unexplained weight loss or weight gain usually indicates worsening COPD. Unexplained weight loss is a sign that your body is having to work too hard to maintain basic functions, like effective breathing. Unexplained and sudden weight gain, on the other hand, is an indicator of fluid retention as a result of lower oxygen levels putting excess strain on your heart. If you experience this kind of unexplained and sudden weight loss or weight gain, contact your physician.
    9. Changes in your mental acuity, including restlessness, confusion, forgetfulness, irritability, slurred speech
      These kinds of changes in your behavior and mental acuity are signs that your body is not receiving sufficient oxygen. If your oxygen levels get too low, you can experience a number of different side effects, and if you become hypoxic, or oxygen deprived, you can experience permanent organ damage. If you experience confusion, forgetfulness, irritability or slurred speech, contact your physician.
    10. New or worsening swelling in your lower extremities that doesn’t go away after resting for one night with your legs and feet elevated
      This swelling is called peripheral edema, and it occurs because COPD affects your circulation, and your lungs and heart can no longer function as efficiently as they should. It can be uncomfortable, as well as signaling that your COPD is worsening. If you experience new or more severe swelling in your feet, ankles or legs that does not go away after rest and elevation, contact your physician.

While each of these symptoms warrants a call to your doctor, keep in mind that the severity of the symptom should be the indicator for how quickly you should call. Any symptoms that cause you to experience serious breathlessness that you cannot resolve, that leave you unable to speak, that cause you to feel confused and act intoxicated or that include a blue tint in your skin warrant immediate medical attention. When it comes to a COPD flare-up, things can go wrong quickly, so it is better to err on the side of caution and call. Make sure you create and discuss an action plan with your health care team so you know what to do if you experience worsening COPD symptoms or a COPD exacerbation.

Frequently Asked Questions: Signs of a COPD Flare-up

Why is COPD worse at night?

Times at which symptoms are worse can vary for patients, depending on a variety of factors. Though many patients experience more severe symptoms in the morning, some people with COPD experience worse symptoms at night.[1] Nighttime arousals are common for people with COPD and patients can awaken with breathlessness, coughing, heartburn, nasal congestion and wheezing.[2] People with COPD are also at an increased risk of sleep apnea, which can cause awakenings and worsening symptoms. If you are experiencing more COPD symptoms at night, talk to your doctor to find out if you should be screened for sleep apnea or nighttime arousals.  

How fast does COPD progress?

COPD is unique to each patient, so your COPD will progress in a way that is unique to your overall health, your lifestyle and other factors, including genetics, age and treatment. COPD cannot be cured, so it will continue to progress no matter what. However, with treatment and lifestyle changes, including avoiding potential risk factors, many people with COPD can significantly slow the progression of their disease. As such, many people with COPD are able to live a long time.

What are the signs and symptoms of a COPD exacerbation?

A COPD exacerbation, also called a COPD flare-up, is a worsening of your COPD symptoms. They can occur slowly over a matter of days, or they can come on quickly, in a matter of hours. Look out for the following signs and symptoms so that you can notify your doctor if you believe you are experiencing a COPD flare-up:

      • Difficulty sleeping
      • Feeling confused or dizzy
      • Fever
      • Increased breathlessness
      • Increased fatigue or weakness
      • Increased quantity and/or quality of mucus
      • Waking up with a headache
      • Worsening cough

Once you have identified the signs of your COPD exacerbations, make note of them as they may begin to show you when a COPD flare-up is coming on.[3]

For more information about COPD and prevention of COPD exacerbation, read:


[1] Miravitlles, Marc, et al. “The Variability of Respiratory Symptoms and Associated Factors in COPD.” Respiratory Medicine, W.B. Saunders, 26 June 2017, www.sciencedirect.com/science/article/pii/S0954611117301841.

[2] Balachandran, Jay, and Mihaela Teodorescu. “Sleep Problems in Asthma and COPD.” American Thoracic Society Patient Education Series, pp.P5-P6, Aug. 2018, https://www.thoracic.org/patients/patient-resources/resources/sleep-problems-asthma-copd.pdf

[3] Lareau, Suzanne, et al. “Exacerbation Of COPD.” American Thoracic Society, American Thoracic Society Patient Education Series, pp.P21-P22, 2018, https://www.thoracic.org/patients/patient-resources/resources/copd-exacerbation-ecopd.pdf.

Additional Sources

“Chronic Obstructive Pulmonary Disease (COPD).” Cedars-Sinai: A Non-Profit Hospital in Los Angeles, Cedars-Sinai, Accessed 13 May 2020, www.cedars-sinai.edu/Patients/Health-Conditions/Chronic-Obstructive-Pulmonary-Disease-COPD.aspx.

“Congestive Heart Failure: From Heart Failure to Heart Success.” Huntsville Hospital, Huntsville Hospital Foundation, P5, https://www.theheartcenter.md/images/pdfs/CHF-Patient-Education-Booklet-English-web.pdf.

“COPD and Heart Failure: What Are the Symptoms and How Are They Related?” Cardiovascular Institute of the South, Cardiovascular Institute of the South, 21 Nov. 2017, www.cardio.com/blog/copd-and-heart-failure-what-are-the-symptoms-and-how-are-they-related.

“COPD Symptoms: When to Call the Doctor.” Cleveland Clinic, Cleveland Clinic, Last reviewed 5 Sept. 2017, my.clevelandclinic.org/health/articles/8704-copd-when-to-call-the-doctor-about-your-symptoms.

“Cough When to See a Doctor.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 21 June 2019, www.mayoclinic.org/symptoms/cough/basics/when-to-see-doctor/sym-20050846.

Johnson, Jon. “COPD and Age: Onset, Life Expectancy, and More.” Medical News Today, MediLexicon International, 16 Oct. 2018, www.medicalnewstoday.com/articles/323350#takeaway.

Lareau, Suzanne, et al. “Exacerbation Of COPD.” American Thoracic Society, American Thoracic Society Patient Education Series, pp.P21-P22, 2018, https://www.thoracic.org/patients/patient-resources/resources/copd-exacerbation-ecopd.pdf.

 Leader, Deborah. “COPD Symptoms: Calling Your Doctor vs. 911.” Verywell Health, Verywell Health, 24 Sept. 2018, www.verywellhealth.com/copd-worse-when-to-call-the-doctor-about-your-copd-914747.

Leader, Deborah. “Why COPD Causes Your Legs and Ankles to Swell.” Verywell Health, Verywell Health, 10 Feb. 2020, www.verywellhealth.com/why-does-copd-cause-my-legs-and-ankles-to-swell-91487.

Nicholson, Anna. “Fever.” COPD.net, COPD.net, July 2015, https://copd.net/symptoms/fever/.

Orenstein, Beth W. “10 COPD Symptoms That Need Attention: Everyday Health.” EverydayHealth.com, Everyday Health, 6 May 2013, www.everydayhealth.com/copd/copd-symptoms-that-need-attention.aspx.

“What Are the Risks of Having COPD and Pneumonia?” Healthline, Healthline, Accessed 14 May 2020, www.healthline.com/health/copd/copd-and-pneumonia-understanding-your-risk#symptoms.

“Wheezing When to See a Doctor.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 11 Jan. 2018, www.mayoclinic.org/symptoms/wheezing/basics/when-to-see-doctor/sym-20050764?p=1.



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