What Does a COPD Flare-up Look Like?

By Jennifer Nelson

Chronic obstructive pulmonary disease (COPD) flare-ups are a leading cause of hospitalization in the United States. Yet, education around COPD flare-ups is still relatively scarce. But that may be changing thanks to a COPD Foundation-conducted two-part national survey of more than 1,000 patients and 200 pulmonologists to identify gaps in knowledge around COPD exacerbations or flare-ups.

The findings of the survey, called COPE (Chronic Obstructive Pulmonary Experience), show that 98 percent pf doctors report discussing flare-ups with their COPD patients, but 62 percent of patients admit to not knowing a lot about them. An additional 16 percent were unaware of what an exacerbation was.

Flare-ups are acute periods when COPD symptoms suddenly get worse and breathing becomes even more difficult. “A persistent increase in shortness of breath, cough and sputum production are typical symptoms,” said Dr. MeiLan Han, an associate professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan.

Han said early warning signs of an exacerbation may differ from person to person. Sometimes patients may think they are developing a cold, but flare-ups are typically a persistent increase in symptoms beyond the typical day-to-day variety. Pateints who have a stubborn increase in shortness of breath, cough and sputum production should call their doctors.

Early warning signs of a flare-up that should be reported to the doctor right away include fever, increased use of rescue medications, change in color or amount of mucus, tiredness lasting more than one day or ankle swelling.

Dangerous warning signs that require a visit to the emergency room or a call to 911 include confusion, severe shortness of breath or chest pain and blue-colored lips or fingers.

Once patients have a flare-up, they’re more likely to experience another one, and each event can reduce lung function. The survey found that patients who have experienced at least one exacerbation have suffered through an average of 22 in their lifetime.

“The most common causes of COPD exacerbations are infections and environmental triggers such as air pollution and allergens, but there are also times when no clear cause can be identified,” Han said.

Developing an action plan is critical to managing exacerbations. Yet, according to the survey, 60 percent of patients don’t have a plan in place.

“COPD patients should work with their doctors to create an action plan, which can help a patient determine what actions to take depending on the symptoms they are experiencing,” said Scott Cerreta, director of Education at the COPD Foundation.

Depending on symptoms, patients may be able to manage some exacerbations at home by increasing the dose of their current medication. More severe flare-ups require a visit to the doctor for an evaluation and change in medication, or a visit to the hospital for observation and more aggressive treatment.

COPD affects 24 million Americans. “Raising awareness amongst patients about COPD management is a step in the right direction to help prevent flare-ups from occurring and preserving lung function as much as possible,” Cerreta said.

Here’s an interactive infographic.