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Signs Your COPD is Getting Worse

What Are the Warning Signs of a COPD Flare-Up?

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Dayton Respiratory Center

Dec 08 2022

4 mins read

COPD (Chronic Obstructive Pulmonary Disease) is a progressive lung disease that gradually worsens over time.

While there's no cure, proper treatments help patients manage the condition and slow its progression. But sometimes — especially in the early stages of COPD — a person only experiences mild symptoms and chooses to ignore them.

The problem? Untreated COPD can lead to lung exacerbations — which can be life-threatening.

Let's dive deeper to understand COPD exacerbations, what triggers them, and how you can identify them.

What Is a COPD Exacerbation?

A COPD exacerbation is an episode of worsening symptoms. The lungs become swollen and inflamed — making breathing very difficult.

COPD Exacerbation | Source: American Thoracic Society

There are two types of COPD exacerbations: sudden-onset and gradual-onset. What's the difference?

  • Sudden-onset exacerbations — sudden worsening of symptoms
  • Gradual-onset exacerbations — slow and steady worsening of symptoms over a period of 4 days

It may take weeks to recover from an exacerbation. And failing to treat them in a timely manner can lead to additional health problems and even death.

What Causes a COPD Exacerbation?

A COPD exacerbation is brought on by increased inflammation in the airways or lungs.

More specifically, some causes include:

  • Lung infections caused by bacteria or viruses — usually associated with colds or the flu
  • Pollution or exposure to second-hand smoke

How Do You Know if Your COPD Is Getting Worse?

Exacerbations can cause irreversible lung damage — contributing to the disease's progression.

For that reason, it's important to recognize the symptoms of an exacerbation and respond quickly. You want to shorten the attack and prevent your COPD from getting worse.

To detect a flare-up, keep an eye out for the following signs and symptoms:

Increased Shortness of Breath

When your COPD gets worse, you may have more trouble breathing. Shortness of breath can make simple activities — like climbing stairs or doing chores — more difficult.

If this happens, it may be a sign that your condition is getting worse.


Air forced through narrow or obstructed air passages in the lungs causes a whistling sound called wheezing.

In people with COPD, it’s most often caused by excess mucus obstructing the airways. Mucus — in conjunction with muscular tightening — further narrows the airways.

If your wheezing intensifies, it could signal a flare-up. If you make strange gurgling or rattling noises when you breathe, it could mean that there is fluid in your lungs.

Changes in Phlegm

When COPD worsens, it can cause two changes in the phlegm you produce:

  • Your production of phlegm increases
  • The phlegm changes color — going from clear to yellow/green

Look out for the change in phlegm color. A greenish color may indicate an infection in the lungs. This is one of the first signals of an exacerbation.

Increased Fatigue or Muscle Weakness

One of the symptoms of COPD is fatigue. This is because your body uses most of its energy for breathing.

If you experience increased tiredness or muscle weakness, it might be because your COPD is flaring up and your body is struggling to breathe.


Edema is fluid build-up in the body — specifically in the ankles and feet.

Why is this common during exacerbations?

Well, COPD can cause a condition called pulmonary hypertension. This happens when the blood vessels connecting the heart and lungs start to thicken — resulting in high blood pressure. When the heart can't pump blood efficiently, excess fluid builds up.

Worsening Cough

Persistent coughing is a symptom of COPD. If your cough gets worse — and makes it difficult to sit or sleep — it might be a sign that your COPD is progressing.

Chest Tightness and Pain

A COPD flare-up constricts the airways — restricting airflow and making breathing difficult. It puts an increased strain on your lung muscles, causing chest tightness.

A study shows that patients experience increased chest pain during COPD flare-ups.

Lower Oxygen Levels

Exacerbations of COPD cause your body's oxygen level to drop. Monitor your body's oxygen levels to predict flare-ups.

Other Signs and Symptoms

In addition to the warning signs above, you might also experience:

  • Early morning headaches
  • Fever
  • Trouble sleeping
  • Difficulty eating
  • Changes in skin and nail color

The symptoms of COPD can vary from one person to another. If you notice anything out of the ordinary, talk to your doctor. You may need to seek treatment for an exacerbation.


COPD already worsens over time, but exacerbations can speed up its progression. The right treatments help slow down lung deterioration caused by flare-ups.

Talk to your doctor and develop an action plan. A COPD action plan will help you identify symptoms that signal worsening COPD. That way, you can prevent life-threatening exacerbations and know when to seek emergency care.

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