What Does a COPD Flare-Up Feel Like? Early Signs and What to Do

As its name implies, chronic obstructive pulmonary disease (COPD) creates marked breathing difficulties. If you are one of 80 million people living with this condition, your symptoms can be controlled with medication and lifestyle changes. Even then, you may still experience occasional flare-ups or exacerbations of the condition. You need to be prepared to handle them, to prevent serious complications and trips to the emergency room. 

Here’s more about COPD flare-ups, their treatment, and tips to help you prevent them.

What is a COPD flare-up?

A COPD flare-up is a sudden worsening of COPD symptoms beyond your usual “day-to-day” changes.

A flare-up is not the same as a “bad day.” While a bad day might improve on its own after some rest and medication, a flare-up can last from a few days to several weeks if untreated, and it rarely improves without medical care.

Flare-ups are serious because they can lead to complications such as acute respiratory failure, permanent lung damage, or heart problems. Experiencing one flare-up also increases your risk of future ones, especially if not managed properly.

Approximately 30% to 50% of people with COPD experience at least one exacerbation each year. Many of these episodes require hospitalization, depending on how severe they are.

How does a COPD flare-up feel? 

A COPD flare-up can feel like your lungs are shrinking or like there isn’t enough air in the room. Many people describe feeling more breathless than usual. Their coughing episodes last longer, become more frequent, and produce more sputum. This sudden change can make people living with COPD feel anxious, which is completely normal. Flare-ups can be unpredictable and frightening.

A COPD flare-up, or exacerbation, often begins quietly: a little more coughing, a bit more breathlessness, and more discomfort in your chest. Within hours or days, those symptoms can intensify, leaving you struggling to breathe comfortably. It’s important to recognize the early signs and act quickly. Early detection and treatment can help you regain control and avert an emergency room visit or worse.

What are the symptoms of a COPD flare-up?

COPD flare-up symptoms are different from person to person, but they usually affect your breathing, energy level, and overall well-being.

You might experience:

• Tightness or heaviness in your chest

• Shortness of breath, even at rest

• Wheezing or louder breathing sounds

• Fever or chills

• Swelling in your ankles or legs

• Faster, shallower breathing

• Trouble finishing your sentences without gasping for air

Coughing often becomes more frequent and harder to control. You might cough up more mucus, which could appear yellow, brown, or streaked with blood. In some cases, it becomes harder to bring up mucus or to sleep comfortably.

You might also feel extremely tired or weak, as though your body can’t keep up. Confusion or drowsiness can be a danger sign that your body isn’t getting enough oxygen and needs urgent attention; otherwise, you may lose consciousness.

Early warning signs of a flare-up

The warning signs of a flare-up often start gradually over 2–3 days and last 7–14 days or more. Recognizing them early can make a big difference in helping you get prompt care.

You might notice:

• Needing to use your inhaler more often

• Waking up at night, gasping for air

• Feeling more tired 

• Losing your appetite

• Feeling more anxious, irritable, or restless

• Coughing more and producing more sputum

When you detect a flare-up early, it’s easier to treat. Early detection also reduces the likelihood of hospital admissions and prevents ongoing lung damage. 

Common triggers of COPD flare-ups

Anything that interrupts your usual breathing pattern could be a trigger. Common triggers include:

1. Infections: About 50–70% of flare-ups are caused by lung or airway infections such as colds, flu, pneumonia, or sinus infections.

2. Your environment: You may experience flare-ups when exposed to air pollution and smog, extreme temperatures, high humidity, smoke, chemicals, dust, and allergens. All of these irritate the airways and worsen COPD symptoms. 

3. Poor medication adherence:  Missing your medications or being inconsistent can lead to a flare-up.

4. While regular exercise helps you, exercising too much and too vigorously is dangerous. Strenuous exercise increases the oxygen demand, strains your respiratory system, and can cause injury. 

5. Stress, anxiety, and psychological distress may worsen your symptoms in the short term.  

What to do during a COPD flare-up

If you experience symptoms of a flare-up or someone you care for has them:

1. Use your medications as prescribed. Pay attention to what makes symptoms better or worse.

2. Avoid known triggers. Stay indoors when pollution is high, and steer clear of smoke or irritants.

3. Get plenty of rest, but avoid lying flat. Use a few pillows to prop yourself up, so your lungs can expand more easily.

4. Practice breathing exercises and techniques such as:

   • Pursed-lip breathing: Inhale through your nose, then exhale slowly through pursed lips.

   • Belly breathing (also called diaphragmatic breathing): Take very deep, slow breaths through your nose, watching your belly rise. Exhale slowly through your mouth. 

   • Tripod position: Sit or stand leaning forward slightly, resting your elbows on your knees or a table to make breathing easier.

Call your doctor if:

• Your rescue inhaler doesn’t help

• You feel more short of breath than usual

• You have a fever or feel generally unwell

Seek emergency care or call 911 if you:

• Struggle to breathe or speak

• Feel intense chest pain

• Become confused or unusually sleepy

• Notice blue lips or fingernails

• Have a rapid heartbeat or cough up blood

Treatment options for flare-ups

Your doctor will treat both your symptoms and the underlying cause. Common treatments include:

• Bronchodilators (e.g., Salbutamol): To open the airways.

• Oral corticosteroids (e.g., Prednisone): To reduce inflammation.

• Antibiotics: If an infection is suspected or confirmed.

• Oxygen therapy: To help maintain safe oxygen levels.

• Non-invasive ventilation (also called CPAP or Bi-PAP)

• Placed on a mechanical ventilator (requires intubation)

If your symptoms are severe, you may need to be hospitalized for IV medications, respiratory therapy, and monitoring.

Most flare-ups improve within about a week, but full recovery can take 4 to 6 weeks. Recovery may take longer if your lung function is poor or if you have other health conditions such as heart disease, stroke, or diabetes.

Creating your COPD action plan

Having a COPD action plan helps you stay prepared and respond quickly when symptoms change. Work with your doctor to develop one that includes:

• Your baseline symptoms: What’s normal for you on a good day?

• Early warning signs: What tells you a flare-up might be starting?

• Medication instructions: Clear directions for both regular and rescue medications.

• When to call your doctor or go to the ER: Know your red flags.

• Emergency contacts: Keep their details handy and share your plan with them.

You can use a color-coded system:

• Green: You’re doing well.

• Yellow: Warning signs, take action.

• Red: Emergency — seek medical help immediately.

Review your action plan regularly with your doctor, updating it as your condition changes.

Share it with your family and caregivers, so they know how to support you. 

Preventing future flare-ups

You can lower your risk of future flare-ups by being proactive:

• Take your maintenance medication daily.

• Get vaccinated against flu, pneumonia, COVID-19, and RSV.

• Avoid exposure to smoke, dust, and pollution.

• Practice breathing exercises.

• Monitor your symptoms daily.

• Keep your rescue inhaler nearby.

• Manage stress and anxiety.

• Eat healthy, stay active, and rest well.

• Visit your doctor regularly for checkups.

Tracking your symptoms using a journal, peak flow meter, or app can help you and your healthcare team identify patterns and make better decisions.

Living between flare-ups

Recovery takes time. It’s okay to lean on others for physical or emotional support. Avoid doing difficult tasks until your energy returns. “Feeling better” can mean different things, but it often includes breathing easier, having more energy, and feeling hopeful again.

Resume your usual activities when your doctor clears you to do so. Be patient with your body; remember, recovery is progress, not perfection. 

FAQs

1. How long does a COPD flare-up last?
   A COPD flare-up can last from 7 to 14 days to several weeks, depending on severity and how early it’s treated.
   
   

2. Can you get a flare-up without an infection?
   Yes, you can. Infections are common triggers, but irritants, stress, or missed medications can also cause flare-ups.
   
   

3. What’s the difference between a flare-up and progression?
   A flare-up is a sudden worsening of symptoms; progression means long-term decline in lung function.
   
   

4. Are flare-ups a sign my COPD is getting worse?
   Not always, but if you have frequent flare-ups, it may indicate worsening disease.
   
   

5. Can stress cause a COPD flare-up?
   Yes, stress can cause a COPD flare-up. Stress can make you breathe faster and tighten your airways, triggering symptoms.
   
   

6. Can all flare-ups be prevented?
   No, all flare-ups can not be prevented. But you can lower your risk by preventing infections (vaccines, hygiene, lifestyle), avoiding triggers in the environment (such as dust, smoke, allergens), and sticking to your care plan.
   
   

7. Do all flare-ups require hospitalization?
   No, if the flare-up is mild and promptly treated, you can be managed at home with your doctor’s guidance.

Conclusion

COPD flare-ups are serious but manageable events. Recognizing the signs early, following your action plan, and working closely with your healthcare team can help you stay in control. Preparation is key. Know your triggers, keep your medications nearby, and have support around you. With proper planning and prompt intervention, you can manage COPD flare-ups effectively and live a full, meaningful life. Still worried? Schedule an appointment  to see your doctor and update your treatment plan today. 

References

1. World. “Chronic Respiratory Diseases: More than 80 Million Affected and Many More Undiagnosed, Warns New WHO and European Respiratory Society Report.” Who.int, World Health Organization: WHO, 12 June 2025, www.who.int/europe/news/item/12-06-2025-chronic-respiratory-diseases--more-than-80-million-affected-and-many-more-undiagnosed--warns-new-who-and-european-respiratory-society-report.

2. Canada, Service. “Not Found.” Www.canada.ca, 13 Oct. 2015, www.canada.ca/en/public-health/services/chronic-diseases/chronic-respiratory-diseases/what-copd-flare-what-prevent-them.html.

3. Agarwal, Anuj K., et al. “Chronic Obstructive Pulmonary Disease (COPD).” National Library of Medicine, StatPearls Publishing, 2023, www.ncbi.nlm.nih.gov/books/NBK559281/.

4. Hurst, John R., et al. “Susceptibility to Exacerbation in Chronic Obstructive Pulmonary Disease.” New England Journal of Medicine, vol. 363, no. 12, 16 Sept. 2010, pp. 1128–1138, https://doi.org/10.1056/nejmoa0909883.

5. Waeijen-Smit, Kiki, et al. “All-Cause Admissions Following a First Ever Exacerbation-Related Hospitalisation in COPD.” ERJ Open Research, vol. 9, no. 1, 4 Aug. 2022, pp. 00217-2022, https://doi.org/10.1183/23120541.00217-2022.

6. American Lung Association. “Prevent and Recover from a COPD Exacerbation or Flare Up.” Www.lung.org, 2023, www.lung.org/lung-health-diseases/lung-disease-lookup/copd/living-with-copd/prevent-flare-ups.

7. American Thoracic Society. “Exacerbation of COPD.” 2018. PDF

8. MacLeod, Mairi, et al. “Chronic Obstructive Pulmonary Disease Exacerbation Fundamentals: Diagnosis, Treatment, Prevention and Disease Impact.” Respirology, vol. 26, no. 6, 2021, pp. 532–551, https://doi.org/10.1111/resp.14041.

9. Beasley, Victoria, et al. “Lung Microbiology and Exacerbations in COPD.” International Journal of Chronic Obstructive Pulmonary Disease, vol. 7, 2012, pp. 555–569, www.ncbi.nlm.nih.gov/pmc/articles/PMC3437812/, https://doi.org/10.2147/COPD.S28286.

10.  “Prevent and Recover from a COPD Exacerbation or Flare Up.” Www.lung.org, 2023, www.lung.org/lung-health-diseases/lung-disease-lookup/copd/living-with-copd/prevent-flare-ups.

11. Weir, Daniala L, et al. “Non-Adherence to COPD Medications and Its Association with Adverse Events: A Longitudinal Population Based Cohort Study of Older Adults.” Annals of Epidemiology, vol. 96, 1 Dec. 2023, https://doi.org/10.1016/j.annepidem.2023.12.003.

12. Laurin, Catherine, et al. “The Impact of Psychological Distress on Exacerbation Rates in COPD.” Therapeutic Advances in Respiratory Disease, vol. 5, no. 1, 8 Nov. 2010, pp. 3–18, https://doi.org/10.1177/1753465810382818. Accessed 11 Dec. 2021.

13. American Lung Association. “Breathing Exercises | American Lung Association.” Www.lung.org, 2022, www.lung.org/lung-health-diseases/wellness/breathing-exercises.

14. Meegada, Sreenath, et al. “Dahl’s Sign: An Indicator of Severe Chronic Obstructive Pulmonary Disease.” Cureus, vol. 12, no. 2, 4 Feb. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7057244/, https://doi.org/10.7759/cureus.6865.

15. Duan, Ruirui, et al. “Pharmacological Therapy for Stable Chronic Obstructive Pulmonary Disease.” Chronic Diseases and Translational Medicine, vol. 9, no. 2, 5 Apr. 2023, https://doi.org/10.1002/cdt3.65.

16. Wageck, Bruna, et al. “Recovery Following Acute Exacerbations of Chronic Obstructive Pulmonary Disease – a Review.” COPD: Journal of Chronic Obstructive Pulmonary Disease, vol. 16, no. 1, 2 Jan. 2019, pp. 93–103, https://doi.org/10.1080/15412555.2019.1598965.