Anticipate COPD Exacerbations (Flares)

Your loved one with COPD has suddenly worsening symptoms. You both may think it's just a bad day, but it could be COPD exacerbation (a.k.a. flare).

Helpful Highlights

  • COPD exacerbations (flares) are worsening symptoms of COPD that are uncomfortable and often disable your loved one.

  • Sometimes they can be managed at home and sometimes they require emergent attention from a provider. It's important to know the difference.

  • Understanding and following the care plan is essential for symptom management, which may prevent flares and keep your loved one out of the hospital.

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The signs of a COPD exacerbation go beyond day-to-day COPD symptoms.  The COPD symptoms become more severe and while everyone experiences exacerbations differently, there are definitive signs.  Sometimes it’s easy to confuse them with other conditions like severe allergies, or a very bad respiratory infection. If your loved one with COPD is experiencing severe symptoms, regardless of the reason, seek to manage them and report them to the primary care provider or pulmonologist as soon as possible.

Signs of impending exacerbation

  • More coughing, wheezing, or shortness of breath than usual

  • Feeling unable to control breathing

  • Changes in the color, thickness, or amount of mucus (whether more or less)

  • Feeling drowsy, tired, or exhausted for more than one day

  • Onset or increased swelling of the ankles or lower legs

  • Increased difficulty sleeping

  • Feeling the need to increase oxygen, if on oxygen

  • Oxygen level lower than normal (as measured by a pulse oximeter)

Signs of active exacerbation and need for emergency care

  • Severe shortness of breath or chest pain

  • Numbness in the hands or feet

  • Bluish color in lips or fingers

  • Confusion, disorientation, or difficulty speaking

  • Significant drop in oxygen level (the provider will have given an acceptable range)

Low Pulse Ox

Exacerbations can last for days or even weeks and may require high-flow oxygen, medications like antibiotics and oral corticosteroids, and even hospitalization.

As lung function declines, exacerbations tend to increase in frequency and severity.  Each time there is a COPD exacerbation, lung function may decline further.

What can you do for your loved one?

You can do a lot to help reduce the risk of exacerbations.

  • Help your loved one to stay on the prescribed COPD treatment plan.

  • Assist your loved one to avoid common triggers.

    • Smoking or being around others actively smoking

    • Indoor and outdoor air pollution - use an air ionizer, stay inside when outdoor air quality is low

    • Irritants such as aerosol sprays, as well as fumes from cooking or cleaning products

  • Keep indoor temperatures cool

  • Ensure everyone washes their hands frequently

  • Control household dust

  • Avoid anyone with active respiratory illness

  • Ensure your loved one has all the medications they need and knows how to take them as prescribed

  • Encourage early use of rescue medications (inhalers, nebulizers, anti-anxiety meds)

  • Encourage your loved one to get regular flu and pneumonia vaccines

  • Help your loved one to practice breathing exercises, relaxation, and body positioning techniques

  • Observe for subtle changes in demeanor or physical well-being and ask your loved one questions about what they're experiencing

  • Encourage your loved one to speak openly with you, their primary care provider, and their pulmonologist (if referred)

  • Coordinate and assist with follow-up appointments with providers and therapists

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