Managing COPD flare-ups

Find out about how to manage a COPD flare-up (exacerbation) and ways you can be prepared.

A flare-up – sometimes called an acute exacerbation – is when your COPD symptoms become particularly severe.

Call 999 if you’re struggling to breathe or have sudden shortness of breath and:

• your chest feels tight or heavy
• you have a pain that spreads to your arms, back, neck and jaw
• you feel or are being sick.

You need to be seen urgently.

It’s normal for your COPD symptoms to vary a bit from day to day. But if your symptoms are worse for two or more days, this is a flare-up (an acute exacerbation).

Signs of a flare-up include:

• feeling a lot more breathless than usual
• you are coughing more
• you are producing more phlegm (mucus)
• your phlegm (mucus) changes colour or gets stickier.

Flare-ups are often triggered by an infection but there may be no apparent trigger. If you get a cold, watch out for any changes in your chest symptoms.

If you think you’re having a flare-up, follow your action plan as agreed with your healthcare professional. Download a copy of our flare-up plan.

Your flare-up plan may include a rescue pack of drugs (antibiotics or steroid tablets or both) that you keep at home. Make sure you know when:

• to take steroid tablets - it’s important not to use these too frequently, because of potential long-term side effects.
• to take antibiotics - this will usually be when you are producing more phlegm (mucus) than usual or it has changed colour, as well as being more breathless for some time despite taking reliever medication.

Your doctor or nurse should discuss this with you at every review appointment. Read more about rescue pack medication.

Make sure you let your doctor or nurse know:

• if you take your rescue pack medication
• if things don’t improve within two days of starting the rescue pack.

If your breathlessness gets worse, but you have no fever and your phlegm is normal for you, the first step is usually to use your reliever inhaler more. Make sure you know what to do – such as increasing the dose or changing how you take your bronchodilator medicine – to help with your symptoms. Many milder flare-ups will respond to this.

If your symptoms pass and don’t develop into a flare-up, remember to tell your healthcare professional what happened.

Current guidance says people with COPD using three or more rescue packs in a year should be offered a review of their condition to check everything has been done to reduce the risk of flare-ups.

Most people can be treated at home if they have a flare-up, but you may need to go to hospital depending on how severe your symptoms are. If you use the ambulance service, make sure to say you have COPD, so you get the right oxygen treatment.

Allow yourself some time to recover after a flare-up. Some people find it can take several weeks or even months to feel completely back to normal.

Hospital at home schemes

Most people with COPD who have a flare-up do not need to be admitted to hospital and can stay at home. But in some areas of the country, people who would be admitted to hospital elsewhere, can also be treated at home. These local hospital at home schemes provide medication and visits by a specialist team. This means you can recover at home where you might feel more comfortable and can be more active when you feel ready. If you would prefer to be treated at home, speak to your doctor or nurse.

If you have more than three flare-ups in one year that require your rescue drugs, ask your GP or nurse for a review.

It may be a good idea to ask for samples of your phlegm (mucus) to be analysed to see if you have an unusual or resistant infection. These can include pseudomonas and atypical mycobacterial infections, such as non-tuberculous mycobacterial infection (NTM).

Your doctor may order a scan of your chest to see if there is an area of damaged lung that makes you more likely to get infections.

If you are more likely to get these infections, make sure you act very quickly when you have a flare-up and be aware your usual rescue drugs may not be effective. Sometimes people who have frequent bacterial chest infections benefit from taking regular antibiotics. This is usually started by specialist teams.

As part of your self-management plan, you should have a plan in place for if your symptoms get worse. Our flare-up tracker can be found in our COPD self-management plan on page 20.

Make sure you have an action plan that you’ve agreed with your healthcare professional so you know what to do if you have a flare-up