Even though treatment of chronic obstructive pulmonary disease (COPD) can help to slow the disease and minimize symptoms, there may be times when nothing seems to be working and symptoms can get considerably worse. This is what is referred to as COPD exacerbation and it has the potential to become life-threating if not treated immediately.

According to a paper published in AJN, American Journal of Nursing in February 2013, exacerbations accelerate the deterioration of lung function. This is part of a vicious cycle where as the disease advances the frequency of exacerbations increases, in turn diminishing lung function. The article states that though patients may recover lung function over the weeks following an episode, many don’t recover to the same lung function as before the exacerbation.

Common Symptoms of Advancing COPD

As previously stated, COPD often causes no symptoms or only mild ones until the disease advances. In the beginning stages of COPD, the symptoms are so mild that they go unnoticed, but as progression occurs, the symptoms begin to worsen. Some of the more common symptoms of advancing COPD include:

  • ongoing cough
  • cough that is accompanied by excessive mucus production, often referred to as a “smoker’s cough”
  • chest tightness
  • shortness of breath which is made worse with physical activity
  • wheezing

The severity of the symptoms of COPD depends on the amount of damage to the lungs. As the damage worsens over time, the symptoms become more and more severe and eventually can interfere with even the simplest day-to-day activities such as walking or even just getting dressed. Smoking increases the speed at which the damage occurs.

Along with the common symptoms as listed, many of those with COPD will suffer from frequent colds and flus. As the disease progresses it can cause other symptoms as well, including:

  • breathlessness with physical exertion
  • swollen feet, ankles, or legs
  • weight loss
  • decreased muscle endurance

Exacerbation Triggers

Exacerbations can be caused by anything that leads to inflammation in the lungs. Understanding what the potential triggers are and making an effort to avoid them can greatly reduce the amount of episodes and hospital visits.

Though pollution and environmental irritants can trigger exacerbation, the majority are caused by bacterial or viral infections. According to an article in the American Family Physician in 2001, bacterial infection is a factor in approximately 70 to 75 percent of COPD exacerbations with viruses being responsible for the remaining 25 to 30 percent.

Other causes of exacerbations in COPD are heart failure and not following the prescribed treatment or maintenance therapy.

Signs and Symptoms of Exacerbation of COPD

COPD exacerbation leads to an increased risk of severe and even life-threatening complications.  Being able to spot the changes in symptoms in order to get proper medical care in a timely manner is crucial. The following are signs and symptoms listed by the COPD Foundation that could indicate an acute exacerbation which is a medical emergency that requires immediate attention:

  • inability to catch breath or speak
  • confusion or excessive sleepiness
  • rapid heartbeat
  • blue or grey fingernails or lips
  • increase in mucus production
  • change in color of mucus to tan, yellow, green, or bloody
  • fever
  • inability to get relief of symptoms from your recommended treatment

Exacerbation Treatment

Although some cases of COPD exacerbation can be effectively treated at home, most require treatment in a hospital.  Treatment may depend on the cause of the episode, such as the use of antibiotics for bacterial infections.

Treatment may also include one or more of the following:

  • bronchodilators
  • oxygen therapy
  • systemic glucocorticosteroids (oral or inhaler)

Due to the increased risk of blood clots in the lung, patients are also often administered prophylactic therapy for deep vein thrombosis as a precaution.

Management and Prevention

Along with prescribed treatment there are several other things that one can do to manage and even help to prevent exacerbations in COPD. The Mayo Clinic suggests the following:

  • stop smoking
  • avoid air pollution
  • annual flu shot to reduce the risk of influenza-induced episodes
  • pulmonary rehabilitation programs, which use a combination of education, exercise, and nutrition counselling

Keeping your regular appointments even when you’re feeling fine, washing your hands regularly and avoiding large crowds during the cold and flu season also help to prevent exacerbations in COPD.



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