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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.



24 thoughts on “10 Warning Signs of COPD Getting Worse”

  1. Avatar sarah says:

    After six weeks on antibiotics and presidone I still feel tired and weak.I get like pains in my chest.is this from copd

  2. Avatar david brians says:

    my copd gets worse every month, constant cough now and shorter distance that I can go, I had a friend with the same symptoms I watched him die in hospital. is there just nothing that can be done, my doctor says ime on everything there is, its a horrible way to go.

  3. Avatar Anita Conway says:

    What do you do if you don't have insurance and the hospital don't do an X-ray. To see how bad you are

    1. Web Admin Web Admin says:

      Please go speak with your doctor if you feel an x-ray is needed.

    2. Avatar Mary says:

      I am in the same situation. This is feeling scary. Nothing is helping. Advair, Albuteral, my nebulizer…nothing helps even for a minute and I can't even put on my socks. I can't afford to go to the doctor.

      this runs in my family and many of my family members died of emphasyma. I'm having anxiety over it which makes me tense up and makes it worse. Scarey…like I'm drowning.

  4. Avatar Judy May Centers says:

    I get winded/breathless and lose my voice when talking ..I have asthmatic copd..what is happening?

    1. Inogen Inogen says:

      Hi Judy, Whenever you feel that your shortness of breath is worsening and it's not being relived by your usual medial treatment, you should contact your doctor immediately so that they can evaluate your symptoms. If you feel like you cannot breathe, please go to the closest emergency room or call 911 immediately.

  5. Avatar Mary says:

    Yes…I should go see a doctor….now! I have a 5000 dollar deductable and it's December which means i'll have to pay another $5000 in january.

    I'm almost out of debt. I will never be able to work and pay for the doctor visit.

  6. Avatar Kimberly Walker says:

    I was just diagnosed with COPD last night, well at 2a this morning. My chest hurts beyond comparison, but I'm sure a great deal of that is pointed at the difficulty at lowering my anxiety from the fear of dying. Correction, I don't fear death. I fear doing so in total pain and discomfort. I had, had a flare up. First breathing treatment did absolutely nothing for me, so they hit me with a second breathing treatment not even an hour later, steroids, and the chest xray. They said I also have a low grade fever. I do hate to admit, I am a smoker, and I do plan to quit, but I will not be doing it cold turkey as I fear the stress on my body by doing so. Can anyone please explain this to me? I really have very little knowledge or understanding of what I have been diagnosed with and the seriousness of it. All I know is the pain I feel right now is probably the worst pain I've ever felt, but I'm sure if it was severe they would have admitted me. Thank you.

    1. Inogen Inogen says:

      Hi Kimberly, We're sorry to hear you're not feeling well. A COPD diagnosis can be overwhelming at first, but we do have some resources to help you educate yourself. Please visit: https://www.inogen.com/blog/how-is-copd-diagnosed/

  7. Avatar Richard says:

    been having breathing issues and steadily getting worse, been having to use my emergency inhalers numerous times a day now, chest pains and it feels like my chest is on fire at time. dizziness and always tired. sometimes it feels like im breathing out the albuterol. I am also alpha 1 antitrypsin deficient which makes things worse.

    1. Inogen Inogen says:

      Hi Richard, It may be time for you to re-evaluate your treatment plan with your primary care doctor. Please ask your doctor if oxygen therapy is right for you. For more information on AAT and oxygen therapy, please visit: https://www.inogen.com/blog/understanding-alpha-1/ and https://www.inogen.com/resources/oxygen-therapy-treatment/what-is-oxygen-therapy/

  8. Avatar Tina Baldwin says:

    I was first diagnosed with End stage COPD five years ago. I let it get to far before talking to the doctor about it. Anyway, my recent visit to my lung doctor came with some disturbing news. I'm at 29% lung function and he informed me, usually people with 35% can't even get themselves to the bathroom. Then he told me I didn't have much time left. Has any one experienced what he has spoken of or seen a family member go through this. Yes, I'm not proud of it but I still smoke. If I didn't I think I would curl up and die. My stress reliever. Can a doctor state the above with any certainty at all?

  9. Avatar Frances Carollo says:

    Tina, my heart goes out to you. At this moment, my Husband of 52 yrs in slowley dying in nursing home. He was diagnosed with ENDSTAGE COPD 12 yrs. ago. had a tumor taken out of his throat. the day he left hospital, he lit up.!! has cut down, as he would say, but damage is done. kidney probems; Aneruism, Diabetes, can't walk to bathroom without getting out of breath.This is an on going illness that there is no cure for. if i could say anything to someone, it would be NO MATTER WHAT IT TAKES, STOP SMOKING. THIS DOES NOT GO AWAY . It take you life, your health, living like a normal person. everything. For me and my sons, it's HELL watching their father slowley die knowing there is NOTHING we CAN DO. my husband in down to 111 lbs. from 168. the sadest thing i've ever had to endure. Take care of yourself, NOW.

  10. Avatar Steph says:

    My heart goes out to all of u. My mom who is 85 has been getting worse every day. I feel helpless I lost my husband 14 yrs ago from.a lung disease. It's very hard watching this again. My mom is my best friend and losing her will put me in a horrible depression

  11. Avatar Lisa says:

    Steph – I`m in a similar situation. My mom is 90 and was diagnosed with COPD in 1/2018. The worst part is, she has had this disease since August 2012, and not one Dr. ever told her she had it. After she was diagnosed, I was able to look back on all her routine chest Xrays over the years and discovered this. That's 6 years wasted with no treatment. Despite all of that, my mom has been doing pretty good. She has stayed at 97% oxygen on room air. The last month, things have gone downhill a bit. When walking, her oxygen levels now drop to 92/93%. Also when she talks, she has a hard time finishing sentences. It's so hard watching someone with this horrible disease. Make sure your mom uses her incentive spirometer, as that can really help improve lung function.

  12. Avatar Carloyn says:

    My husband has had COPD for over 10 years. He's on oxygen24/7 and uses INOGEN during the day and the big oxygen tank for night. The pulmonary Dr. said he couldn't do anything more but he is sending him for Pulmonary therapy to be evaluated for the treatments. He feels they won't be able to do anything because his lungs are gone. What do we expect from now on in?

  13. Avatar Adrienne. says:

    Hi it is very horrible watching someone with copd scared to death cuz they ca t breath. My best friend slash mom has copd. But she got pneumonia n it sent her into a spell n had to b put in ICU that nite she went Into distress n had to b put on a ventilator took it out. Put it bk. She is off now n doin better but had to learn how to walk again. She is still in rehab went to hospital 9/11/2019. But what are symptoms of copd. Cuz I have started out with some kinda flu like symptoms. but I have a phelm that jus wont go away.. could that mean copd for me

  14. Avatar Jenny says:

    Please quit smoking as soon as possible. My mother only has a actual lung function of 10% without oxygen this is heart breaking to watch this disease progress, we are in the finale stage…she in at her 4th admission in 2 weeks she will next go to nursing home rehabilitation for two weeks then we will reevaluate. She’s only 68. Her dr today told me her lungs are comparable to Swiss cheese. I knew she was bad but hearing this was devastating you do not want to die from this disease smoking she just got out of the nursing home a month ago and her downfall has been unbelievable.she came home and started smoking. She is in total denial that it’s the COPD and there’s something else that must be wrong and has continued to smoke. If anyone that’s a smoker reads this I hope I can reach even just one person. She only weighs 96lbs because her body burns any nutrition she receives because her accessory muscles have to work so hard. This has killed me to watch my mother die from COPD-so Please quit smoking!!! Live the best quality of life you can or you will most definitely suffer if you continue to smoke…

    1. Inogen Inogen says:

      Thank you for your wonderful words of advice Jenny!

  15. Avatar Cynthia Penn says:

    …thanks for your message ‘ALL’ …I do have coped AND smoke but for the pass couple days I stopped, I only do that when I know I need a tune-up at the ER….but w this cov19 I stay clear of the Hospital…soooo I’m here thinking . What should I do?

  16. Avatar Carol says:

    I have end stage COPD from smoking and bronchitis, along with allergy induced asthma. I just wanted to say if any of you don't have insurance and you are not old enough you can still get medicare. They will send you to get pulmonary function tests and you can get medicare if you have COPD. That is 1 of the diseases medicare approves no Mather your age. If you have a $5,000 deductible like 1 lady does apply for medicare. I applied and was approved 1st time after have my PFT'S. They can also help you get cheaper insurance through medicare as a 2nd insurance. I have 2nd insurance only because I need dental real bad. It doesn't cost me anything. You may even qualify for medicaid. There is no need to go without medical or a high deductible when you have COPD. NO Dr. can tell you that you don't have long to live especially at I think she said 35% I may be wrong but 35% I think is still stage 3 not 4. What a cruel Dr. to say that. As long as you exercise like walking keeping tone you can stay at 35% for a long time. I got lazy and wasn't walking but now with my POC I am taking it slow but today I completed my goal of 1,000 steps per day. I actually did 1,044 today. I bought me a watch that tells me my 02 level, my steps, b/p, my heart rate, sleep data, heart rate value which really has no value. Lots of things on this watch from Amazon it was pretty dirt cheap. I was in the hosp last year because my chest was hurting. My blood pressure taken during my stay reached 186/71 and the nurses came racing in but my watch told me before they tested my B/P. Nurses were shocked I was warned and knew. It turned out ok in the end. It also tells you how much you are straining, like when it's hard on your heart. I love it. Taking PFT'S next month but I am going to walk and strengthen my heart because I have been lazy. Last time I took it, I raised it by 3 points. This time I want it to at least remain the same so that means working for those few points so I can get back to stage 3. The more you exercise and walk even if it's in your apartment like I do I just walk the hall. Today I did all those steps in my small apartment. God bless you all. Don't ever let your Dr tell you, you won't have much longer to live. Do research on your condition. I have a friend in Ireland that has been living on 10% lung capacity for a few years now. God bless you all and remember only God knows when your time comes.

  17. Avatar Carol says:


  18. Avatar Carol says:

    Well I had my pulmonary function test(pft) and I am at 29%lung capacity. That is 1% below stage 3. Because of C-19 rehab was hard for me to find. I accept an offer an hour from home after accepting I received a call back that a hospital 4-5 miles from me is just opening this week. I will start next week 3x's a week for an hour. Medicare pays for it. Found out they only pay for so many classes and it sucks. Because I was in a class a few years ago they have to get my records and find out how many more classes I can take. To clear something up I had said you can qualify for medicare if you have COPD. However, I meant SS disability if unable to work. My second insurance is Medicaid because my income is so low. I now have an inogen5 but still scared to go out with it very far. It's all in my head because I do fine when I use it. I saw my pulmonary Dr and he told me my lungs were to far gone to get valves. He wasn't my usual Dr. My pulmonary Dr. had moved on. Make sure you ask your pulmonary Dr. things this Dr. I don't like. I found out he's the only Dr left in the office until next year. The other Dr's left next year they have a Dr. coming in but she will only be there for 1 year then I have to start all over again with another pulmonary Dr. So I am looking now for a Dr. I can stay with. I feel if my lungs are now 2 bad to get valves then why didn't my other Dr. suggest I get them when I was in better condition. SOOOO I plan on getting in better shape and contacting a major medical center an hr away from me and see if I can qualify. I am actually going to contact them and see what their requirements are so I can try to meet that goal. Don't give up just because a Dr tells you bad things. Get another Dr. As the Dr was leaving the room he said your lungs would be better if you lost weight. Granted I need to lose weight but most is in my belly where I have a hiatal hernia almost covering my esophagus and had an ischemic bowel so I wont ever lose my belly. I thought that was very rude of him and when I got home I called the office and asked for a different Dr. that's when I found out he's the only one available until the woman Dr. comes in. They don't tell you these things because they still want your money and keep you as a patient. GRRRR Thank you for this platform to allow me to vent. Please if you are smoking quit. Smoking makes this disease progress further faster. All my other tests other then for this disease is ok. Imagine how long I could live if I never smoked! My dad is 86 my mother 87. My dad has emphysema smoked like a fish so did my mother but she doesn't have COPD. I won't live to be either of their age as next year I will be a young 70 in Aug. Funny how this disease works, some get it some don't. It's a horrible disease to have to live with especially when like me scared to go out and end up home bound.

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