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A COPD flare-up is a sudden worsening of symptoms that can be scary and even life-threatening. What do you need to know about these flare-ups, also called exacerbations?

If you have had chronic obstructive pulmonary disease  — or COPD — for a while now, you may have noticed periods during which your symptoms suddenly became much worse. These are called exacerbations or flare-ups, and they're characterized by more severe shortness of breath, more intense coughing, and increased wheezing. COPD flare-ups can be more than scary. They can send you to hospital, and can be fatal in extreme cases. What's more, flare-ups can also have long-term consequences. 

Air pollution and acute respiratory tract infections like bronchitis or pneumonia are the most frequent culprits, but unrelated health issues like heart failure can also trigger a COPD exacerbation, and sometimes these flare-ups happen for seemingly no reason at all. COPD patients should be familiar with the ways in which they can reduce their risk of a flare-up, know how to recognize a flare-up, and should be equipped with the knowledge they need to manage flare-ups in the best possible way. 

COPD flare ups: Recognizing the red flags

COPD exacerbations lead to a rapid change in lung function, leading to symptoms like: 

  • Increased shortness of breath. You may be unable to take deep breaths, or feel like every breath is a struggle. 
  • More coughing, because coughing is the lung's defense system against irritants.
  • Wheezing. If you "whistle" as you breathe, that's a sign that your airways have narrowed. 
  • More mucus, which may be denser and have a different color.
  • Sleep disturbances and tiredness, which can be a sign that you're not getting enough oxygen.
  • Mental changes, like being confused, feeling down, or being forgetful. Once again, this can indicate that you're not getting as much oxygen as you need. 
  • You may also notice a fever.
  • Swollen ankles are not unusual.

How should you manage COPD exacerbations?

First off, don't ignore the red flags that point to a deterioration in your health and hope things will get better on their own — follow the plan you and your doctor agreed on and seek medical attention if you're in doubt. 

Your way of managing a COPD flare-up depends on how severe your COPD is, and may include:

  • Using your relief (short-acting) inhaler as directed.
  • Using oral or inhaled corticosteroids, which fight inflammation, as directed. Patients who aren't already regularly taking corticosteroids may have them added to their treatment during a flare-up.
  • In more severe cases, an oxygen tank can be vital.

COPD exacerbations sometimes require hospitalization 

Some COPD exacerbations can be managed at home with the right medications, but it's also not unusual for a flare-up to necessitate hospitalization. Always seek medical attention right away if your usual way of managing a COPD flare-up — short-acting bronchodilators, corticosteroids, and sometimes oxygen therapy — do not relieve your symptoms, or don't have enough of an impact. 

You may require a ventilation device, which your hospital can help you with, as well as other treatments. They can include more serious brochodilators like intravenous theophylline, IV fluids to fight dehydration, and diuretics to expel excess water from your system. If you are fighting a bacterial infection or are at risk of one, antibiotics also come into play. 

COPD flare-ups: When is it time to call 911?

While many COPD flare-ups can be managed very well, make no mistake — they can be life-threatening, and yes, fatal, as well. Seek immediate medical attention if: 

  • You experience chest pain
  • Your shortness of breath is severe
  • You have blue lips
  • You suffer from mental agitation, confusion, disorientation, or drowsiness

Can you avoid COPD flare-ups?

Maybe not all of them, but there are steps you can take to try to prevent COPD exacerbations — and recognizing your triggers is a big oart of that. To minimize the number of flare-ups you suffer:

  • Do not smoke and avoid exposure to second-hand and third-hand smoke as well. 
  • Stay away from people with respiratory infections.
  • Use your medications exactly as prescribed. 
  • Stay up to date on your annual flu vaccine as well as a pneumococcal vaccine. 
  • Don't use scented products in your home or cosmetics, and if possible, ask people you often see to avoid perfume as well. 
  • Wash your hands regularly and well (soap and water, at least 20 seconds) to reduce your odds of picking up an infection. Never touch your eyes, nose, or mouth with unwashed hands. 
  • Live a healthy life — eat well and exercise regularly. 
  • If you live in a highly-polluted area, look at the air quality forecasts and avoid going out on bad days.
  • If you still work with substances that can trigger flare-ups, consider looking for a role that is better for your lung health. 
Finally, always ask your doctor if you have any questions about how to better manage your chronic obstructive pulmonary disease, both all the time and during a flare-up. An informed patient is a patient who can handle everything that comes their way in the best possible manner. Being educated about your COPD can not just make for a better quality of life, but actually save your life, too. 

  • Photo courtesy of SteadyHealth
  • www.ncbi.nlm.nih.gov/pmc/articles/PMC4131503/
  •  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282915/
  •  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795571/
  •  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633267/
  •  ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707157/

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