Acute Exacerbation of COPD

The key to managing your COPD is to reduce the frequency of these exacerbations.

Chronic obstructive pulmonary disease (COPD) exacerbations are severe health events. An acute exacerbation of COPD (also known as an AECOPD or flare-up) happens when someone with COPD has new or worsening symptoms for at least 48 hours. The average person with COPD experiences two such episodes annually. One in ten COPD exacerbations requires hospitalization.


Since COPD is a long-term progressive disease, exacerbations become more serious and happen more often as the disease worsens. Unfortunately, the more often these flare-ups happen, the faster the lungs deteriorate as they can cause permanent damage. Therefore, it is vital for people with COPD to be aware of their respiratory symptoms, use inhalers properly, and have regular medical follow-ups.


If you think you’re experiencing an exacerbation, consult your COPD action plan and get medical help before symptoms get out of control. Typically, it’s important to reach out to your doctor within two days. By doing so, you can reduce further damage to your lungs and potentially avoid a long hospital stay.

COPD Exacerbations
Painting the picture of a COPD flare-up
<div class="title">COPD Exacerbations<br />
Painting the picture of a COPD flare-up</div>


It is very important to recognize the signs of a COPD exacerbation and take them seriously. Patients need to consult their action plan and/or tell their doctor right away if they notice any changes, such as:

• Worsening cough

• Worsening shortness of breath

• Increased mucus or phlegm

• Change in the colour or consistency of mucus

• Fever

• Symptoms of a cold (e.g., runny nose, sore throat, headache)

• Tiredness

• Generally feeling unwell


If a COPD exacerbation isn’t treated right away, it can cause severe symptoms. These symptoms are signs of an emergency and the person or their loved one should call 9-1-1 immediately:

• Blue, white, or blotchy skin

• Blue nails

• Extreme shortness of breath

• Chest pain

• Confusion

• Weakness

• Reduced level of consciousness


Anything that causes an inflammatory process within the lungs can trigger a domino effect leading to an exacerbation. During this process, air passages become swollen and produce excess mucus. An exacerbation can be triggered by:

• Bacterial or viral infections (e.g., pneumonia or seasonal flu)

• Environmental conditions (e.g., air pollution)

• Seasonal allergies (e.g., hay fever)

• Underlying medical conditions (e.g., congestive heart failure)

• Unknown cause (up to one-third of cases)


The most common causes of exacerbations are viral and bacterial respiratory tract infections (i.e., chest infections). Generally, more people have COPD exacerbations during the flu season than at any other time of year.


The diagnosis of a COPD exacerbation is usually made based on the person’s history of illness. The criteria are an increase in shortness of breath, cough, and/or mucus production for at least 24–48 hours. On examination, people may have low oxygen levels (this can be checked in the office using a device placed on the finger called a pulse oximeter), wheezes, noisy breathing, pus or blood in the phlegm, and they may be using their throat or small chest muscles to help them breathe.


Most people can be diagnosed with a COPD exacerbation after a history and physical exam only. Depending on the presentation, especially if the doctor wants to rule out another medical condition, other tests may be ordered, such as a chest x-ray or bloodwork. These tests should not delay treatment for a COPD exacerbation, however.

Treatment Options

When a person is diagnosed with COPD, they should set up a COPD action plan with their doctor. COPD action plans detail what to do in case of worsening or severe symptoms. They show what steps to follow to increase inhaler dosages, which prescription medications to take (if applicable), who to contact if feeling worse, and when to visit the hospital.


Not all people will have a COPD action plan, but most are eligible for one. Talk to your doctor today to set one up. COPD action plans are so important because time is of the essence during an exacerbation and the fastest treatments are at-home ones.


The treatment of a COPD exacerbation depends on its cause and severity.

If an exacerbation is caught early, treatment may include:


Also known as puffers, they deliver medication straight into your lungs. As you press down on the mechanism, you take a deep breath in and hold the breath for the medication to reach the lungs.

Corticosteroid pills

This is a type of anti-inflammatory medication. It reduce inflammation, making it easier for air to travel through the lungs.

Antibiotic pills

Antibiotics are medicines that fight bacterial infections. They work by killing the bacteria or by making it hard for the bacteria to grow and multiply.

Secretion clearance techniques

These techniques such as coughing and huffing, chest physiotherapy, etc. are essential to removing excess mucus so that you can breather easier.

These treatments open up the airways, lower inflammation, kill bacteria, and help remove mucus plugs, respectively. When these are used early, many people can stay home and recover to their baseline within a few days or weeks.

If an exacerbation becomes more severe, more treatment is required. Depending on the severity of the exacerbation, hospitalization may be necessary and treatment may include:

Nebulized inhaled bronchodilators

A nebulizer changes medication from a liquid to a mist so you can inhale it into your lungs. It helps get the medication deep into the lungs where it’s needed most.

IV Antibiotics and/or Corticosteroid

Similar to it’s pill version for it’s effects. But the intravenous route is known to be the fastest way to deliver drugs.

Oxygen Therapy

It’s required when people’s oxygen saturation (the amount of oxygen in the blood) becomes too low. It “tops up” blood oxygen levels to prevent the life-threatening effects of low oxygen.

Humidified High Flow Therapy

It delivers high flow of air/oxygen that is heated and humidified. This therapy helps with symptoms such as mucus secretions, persistent cough and breathlessness.

And in the case of acute respiratory failure, where you are likely hospitalized:

• Noninvasive positive pressure ventilation / BiPAP (the person remains awake and a machine helps them breathe with a mask)

• Intubation and mechanical ventilation (the person is sedated and a machine helps them breathe with a tube placed down the throat and into the airways)

• Intensive Care Unit (ICU) stay

To get control of a severe exacerbation, doctors need to stabilize a person’s oxygen levels, reduce lung inflammation, and eradicate infections. The person may also need additional treatment to support their heart, blood pressure, or other organs. This usually requires many different treatments and possibly several days in the ICU.


Recovery from a severe COPD exacerbation may take days to weeks to even months. Once recovered from a COPD exacerbation, people should meet with their health care team to determine whether there is anything they can do to prevent the next episode. Some people with severe COPD may be referred to a respirologist (lung specialist) and may receive prescriptions for daily antibiotics. An exacerbation often leads to a referral to pulmonary rehab. Others with severe COPD may even be referred for surgery to help remove damaged portions of the lungs.


Frequently Asked Questions

Prevention in this disease is key. The best way to prevent an exacerbation is by using your inhalers properly and regularly and knowing your symptoms.

If you smoke, seek help to stop or cut back. Make sure you are up to date with routine immunizations. Take note of what triggers your flare-ups. Check in regularly with your medical team and attend regular medical follow-ups.

Ask your doctor about possible supplements or vitamins, since a 2019 study showed that Vitamin D supplementation for severely deficient or hospitalized COPD patients can reduce number of future episodes and hospital admissions.

Consider attending lung health classes or pulmonary rehabilitation if available in your area. Try to eat nutritious meals and participate in movement or exercise that is appropriate for you.

Although you may still experience flare-ups, these steps will help you recognize and take control of them quickly.

If caught and treated early, most exacerbations can be treated at home. However, one exacerbation tends to lead to another, and another, and so on. Each one affects lung function and your ability to breathe.

Too many exacerbations can even push you into the next stage of COPD.

In this Canadian research paper, Dr. Samy Suissa studied the files of 73,106 Quebec patients who were hospitalized with COPD between 1990 and 2007.

The results show, on average, that patients who have a first exacerbation do not have another for five years. But, the average time between the ninth and tenth exacerbation is less than four months. The more exacerbations someone experiences, the sooner the next one may occur.

Also, after the second severe exacerbation, patients were three times more likely to have a third exacerbation. By the time they had their tenth exacerbation, they were twenty-four times more likely to have another severe exacerbation.

The complications can be severe if you don’t seek immediate treatment when experiencing a COPD exacerbation.

These complications can include sepsis, which is a life-threatening medical emergency that happens when the blood becomes infected and the person’s body has an extreme response to that infection.

Other possible complications include pulmonary fibrosis, which is scarring of the lungs, or even acute respiratory failure—which is fatal if not given appropriate treatment.

Acute respiratory failure is a complicated process that occurs when the lungs can’t transfer oxygen into the blood and/or take carbon dioxide out. In turn, the organs can’t get enough oxygen-rich blood to function.

Part of the underlying reason for this is that the lung passages are extremely inflamed and the air sacs have lost their elasticity and are distended. Additionally, the lung muscles become severely fatigued during a COPD exacerbation.

When patients are experiencing acute respiratory failure, they start to have very rapid shallow breathing and other symptoms from not having enough oxygen in their bodies. If not treated quickly with oxygen and breathing machines (mechanical ventilation), acute respiratory failure is fatal.

Make sure you discuss with your family members or substitute decision-makers about your wishes for treatment, in case you are ever unable to speak for yourself.

The average length of stay in hospital for a patient having a COPD exacerbation is seven days. Sometimes, this includes some time in the intensive care unit (ICU).

Hospital stays can usually be avoided by getting medical help as soon as you notice new symptoms.