COPD Flare-Ups

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COPD Flare-Ups

Topic Overview

When you have COPD, especially if you have chronic bronchitis, you may sometimes have sudden attacks where your breathing and coughing symptoms suddenly get worse and stay that way. These attacks are called COPD exacerbations, or flare-ups.

With treatment, many people recover and return to the same level of shortness of breath they had before the attack.

These attacks are often life-threatening. If your symptoms suddenly get worse, and if taking your medicine doesn't help, have someone take you to the emergency room. Call 911 if needed.

COPD attacks often occur more frequently, last longer, and are more severe the longer you have COPD.


The two most common causes of a COPD attack are:1

  • A lung infection, such as acute bronchitis or pneumonia. Infections are the most common cause of COPD attacks. Infections usually are caused by viruses but can also be caused by bacteria.
  • Air pollution.

Other causes may include heart failure, allergic reactions, inhaling food or stomach contents into the lungs, and exposure to temperature changes or chemicals. In about 33 out of 100 attacks—about a third—the cause is not known.1

Here's what happens during an attack:

  • Your lungs may suddenly produce more mucus. Or the airways of your lungs (bronchial tubes) may suddenly get narrower.
  • These two things reduce the airflow in your lungs.
  • And that makes it harder to breathe and makes your coughing worse.


In a COPD attack, your usual symptoms suddenly get worse:

  • You have more shortness of breath and wheezing.
  • You have more coughing, with or without mucus.
  • You may cough up more mucus than usual, and it may be a different color.

Some people also have a fever, insomnia, fatigue, depression, or confusion.


Treatment of a COPD attack depends on how bad it is. It may involve several visits to your doctor's office or clinic. Or you may need to be treated in the hospital.

To treat COPD attacks, experts recommend:

  • Bronchodilators, which are medicines that relax the bronchial tubes and make it easier to breathe. These medicines may include:
    • Inhaled anticholinergics (such as ipratropium).
    • Beta2-agonists (such as albuterol).
  • Oral corticosteroids, which are medicines that reduce the swelling in your airways and may make breathing easier. They are typically given for 5 days to up to 14 days to those who aren't already taking them as part of their long-term treatment.
  • A machine to help you breathe. This is called mechanical ventilation. It is used only if medicine is not helping and you are having a very hard time breathing.
  • Oxygen, to increase the amount of oxygen in your blood.
  • Antibiotics, which are often used when a bacterial infection is considered likely. People with COPD have an increased risk of pneumonia and frequent lung infections. Although most infections are caused by viruses, some are caused by bacteria. Most studies support the use of antibiotics. But some experts believe that since most breathing attacks are caused by viruses, antibiotics should not be used unless there is a known bacterial infection.

Treatment may also include:

  • Intravenous (IV) fluids, to treat dehydration.
  • Other bronchodilators, such as intravenous theophylline. These are used only if other treatments don't work.
  • Diuretics, which remove water from the body by making your body produce more urine. These medicines are used if you are suspected of having heart failure.



  1. Global Initiative for Chronic Obstructive Lung Disease (2010). In Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Available online:


ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerKen Y. Yoneda, MD - Pulmonology
Last RevisedNovember 29, 2011

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