COPD Exacerbation - Definition, Signs, Symptoms, and Treatment

July 5, 2022

COPD can be a difficult respiratory illness to manage daily. Individuals contending with the condition can have good days and bad days. Patients have to make sure they are staying as healthy as possible to prevent the disease from worsening. Being aware of COPD exacerbation is critical for lasting health.

what is a copd exacerbation

What Is A COPD Exacerbation?

COPD exacerbation is a gradual worsening of the disease. This means a patient may go from stable management of the condition to needing more assistance with breathing regularly. Instances of difficulty breathing become more frequent and may last longer. There are many reasons why COPD exacerbation may occur.

What Causes COPD Exacerbations?

The most common cause of an exacerbation is infection in the lungs or airways (breathing tubes). This infection is often from a virus, but it may also be caused by bacteria or less common types of organisms. Exacerbations can also occur from inhaling irritating substances from the environment like air pollution, or from severe allergies. The lungs react to infection or irritating substances by developing inflammation that makes the airways narrow from muscle tightness, swelling, and mucus. These changes in the airways cause the increased signs and symptoms

How Can Your Allergies Affect COPD?

People with allergies or asthma may experience breathing difficulties due to environmental triggers. Individuals with both COPD and allergies or asthma may experience a worsening of their symptoms due to an allergic reaction. Allergies compound the issues with breathing COPD patients already have.

Minimizing exposure to allergens is one of the best ways to reduce attacks. Avoid indoor allergens like dust by keeping your home clean and using an air purifier to improve indoor air quality. Take off your shoes when coming from outdoors to prevent bringing outdoor allergens inside.

Reducing time outdoors during allergy season can help reduce attacks. Check daily pollen counts during the spring and summer. And if allergic to mold, check mold counts during the fall.

Can Your Allergy Medications Result in COPD?

A person with COPD who also has allergies should discuss their treatment options with a doctor. This is because some medications may interact. For this reason, people should always check with a doctor before using prescription drugs or over-the-counter (OTC) drugs for asthma, allergies, or COPD.

Drugs such as inhaled steroids, decongestants, and inhalers may help ease airway inflammation. Some OTC medications, such as diphenhydramine (Benadryl) and cetirizine (Zyrtec), may help with the symptoms of allergies.

What is an Allergen?

An allergen is any substance that causes an allergic reaction. Allergens can be foods. For COPD patients with allergies, allergens are airborne particles that inflame the airways and sinus passages. Airborne allergens include dust, mold, pollen, and pet dander. Allergens do not affect everyone. Those with allergies are just more susceptible to them and must take extra precautions.

Which Allergens Are Responsible for COPD Exacerbations?


Pollen is one of the most common allergens in the United States. Over 67 million people suffer from allergies, and of those 67 million, 81% say they are allergic to pollen. 

Pollen is an airborne allergen, which is picked up and carried by the wind. Various trees, grasses and weeds create pollen, which can cause hay fever, irritate your sinus passages, cause rhinitis and irritate your eyes and skin. If you have a pollen allergy it’s likely you dread the spring, summer and fall seasons when pollen counts can be at the highest levels. 

One way to combat pollen allergies is to plan and prepare. Knowing what pollen you’re allergic to and treating the symptoms before they become overwhelming allows you to reduce the amount of impact they have on your life.

Air Pollutants

Air pollutants are the result of human industry and can be found all over the world. They are particulate matter (often referred to as particle pollution), ground-level ozone, carbon monoxide, sulfur dioxide, nitrogen dioxide, and lead.

Toxic air pollutants, also known as hazardous air pollutants (HAPs), are those pollutants that are known or suspected to cause cancer, other serious health effects (including reproductive effects or birth defects), or adverse environmental effects. EPA is working with state, local, and tribal governments to reduce air emissions of HAPs to the environment.

Examples of HAPs include benzene, which is found in gasoline; perchloroethylene, which is emitted from some dry cleaning facilities; and methylene chloride, which is used as a solvent and paint stripper by several industries.

Household Chemicals 

Household chemicals may be used to help clean the home or freshen the air, but also may release harmful airborne toxins that can aggravate any respiratory condition.

Paints, cleaning supplies and personal care products (think deodorants and hair sprays) are among common products that send a host of chemicals into the air. These air pollutants — some of the sweet-smelling — now contribute as much to lung-irritating ozone and tiny airborne particulates as does the burning of gasoline or diesel fuel.

There is also a class of pollutants known as volatile organic compounds. Most are derived from petroleum or other fossil fuels. These VOCs are hundreds of diverse chemicals that easily evaporate. These gases then may linger in the air.

Tobacco Smoke

Environmental tobacco smoke is a contributor of air pollution particles. These fine particles are a risk factor for chronic lung disease which can be debilitating and sometimes fatal. They can lead to conditions such as asthma, bronchitis, and emphysema, and are also a risk for lung cancer. They are high risk for anyone with COPD.

Researchers found that smoke from cigarettes produced 10 times as much particulate matter as a running car, comparing the first hour after starting the engine with the first hour after lighting the cigarettes. While smoking is restricted for health reasons in many countries, it's not always associated with air pollution.


Dust can be found everywhere, inside and outside the home. It can be airborne from dried earth outside or the result of our own flaking skin. Keeping a clean home is one measure someone can take when they are allergic to dust. Using air filtration systems in the home can reduce the amount of dust in the air.

Dust mite allergy is an allergic reaction to tiny bugs that commonly live in house dust. Signs of dust mite allergy include those common to hay fever, such as sneezing and runny nose. Many people with dust mite allergy also experience signs of asthma, such as wheezing and difficulty breathing.

COPD Exacerbation Symptoms

Exacerbations are usually caused by a viral or bacterial lung infection, but they may also be triggered by things or situations that make it difficult for you to breathe, such as smoking or being exposed to smoke or air pollution.

The most common signs and symptoms of an oncoming exacerbation are:

  • More coughing, wheezing, or shortness of breath than usual
  • Changes in the color, thickness, or amount of mucus
  • Feeling tired for more than one day
  • Swelling of the legs or ankles
  • More trouble sleeping than usual
  • Feeling the need to increase your oxygen if you are on oxygen. If measured, your oxygen levels will be lower than normal

Emergency Care for COPD Exacerbation Symptoms

If you have any of the following symptoms, call 911:

  • Chest pains
  • Rapid breathing or heart rate
  • Blue or gray color in your lips or nails
  • High fever, especially with cold or flu symptoms (like shaking chills)
  • Disorientation, confusion
  • Slurring speech

Depending on how bad your COPD flare-up is, you may have to stay in the hospital overnight, over the weekend, or up to a week in some cases. Often, the first thing a doctor, nurse, or emergency medical technician (EMT) will do is give you extra oxygen (often called oxygen therapy). Your vitals -- pulse, temperature, and blood pressure -- will also be checked.

How Long Does A COPD Exacerbation Last?

Exacerbations can last for days or even weeks, and may require antibiotics, oral corticosteroids, and even hospitalization. As your lung function declines in the later stages of COPD, exacerbations tend to increase in frequency. Each time they occur, they may leave behind permanent, irreversible lung damage, so it’s important to learn how you can reduce your risk. Learn the early warning signs so you can take pre-emptive measures to reduce the severity of the attack.

Once an attack begins it is important not to panic. Know the difference between symptoms of an attack you can manage on your own with a call to your doctor and more dramatic symptoms that may require a trip to the emergency room.

COPD Exacerbation Treatment 

Home Treatments

Some exacerbations can be treated at home. The use of oxygen therapy either with oxygen tanks or an oxygen concentrator can help alleviate symptoms. For severe cases, the use of certain medicines can help. Antibiotics and systemic corticosteroids are most commonly prescribed. These medicines can be delivered using an inhaler or nebulizer to direct the medication quickly to the lungs.

Can COPD Exacerbation Cause Other Health Problem Development?

For reasons that aren't fully understood, COPD can increase your risk of heart disease, including heart attack. Lung cancer. People with COPD have a higher risk of developing lung cancer. High blood pressure in lung arteries. People with COPD may also experience a greater rate of respiratory infections. They are more likely to catch colds, the flu, and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue.

Because of the debilitating effects of COPD many patients may also go through periods of depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with a serious illness can contribute to the development of depression.

How To Prevent COPD Exacerbation

Unlike some diseases, COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease. The majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke — or to stop smoking now.

If you're a longtime smoker, these simple statements may not seem so simple, especially if you've tried quitting — once, twice, or many times before. But keep trying to quit. It's critical to find a tobacco cessation program that can help you quit for good. It's your best chance for reducing damage to your lungs.

Tips For Dealing with Allergies If You Have COPD

Managing allergies with COPD requires first detecting what allergens you are most sensitive to. If household dust is a problem, try to reduce dust with regular house cleanings and the use of air purification systems indoors.

If seasonal allergies are a problem, limit your time outdoors during the spring and summer and check pollen counts to see when conditions are most severe. Try removing your shoes when you come in from outside to prevent bringing airborne allergens such as pollen into your home.

You can also have your home checked for mold if you are responding to mold spores. Fall allergy season is also bad for mold allergies and you should keep abreast of mold counts during the autumn.

Patient Outlook of COPD Exacerbation

The outlook for COPD varies from person to person. The condition cannot be cured or reversed, but for many people, treatment can help keep it under control, so it does not severely limit their daily activities.

But in some people, COPD may continue to get worse despite treatment, eventually having a significant impact on their quality of life and leading to life-threatening problems.

Many people will find that managing their COPD requires a positive outlook and a disciplined approach to their health. Stopping harmful habits such as smoking and continuing regular oxygen therapy can help add quality to life for even the illest COPD patient.

COPD Exacerbation Treatment Options


Bronchodilators are a type of medication that make breathing easier by relaxing the muscles in the lungs and widening the airways (bronchi). They're often used to treat long-term conditions where the airways may become narrow and inflamed, such as asthma, a common lung condition caused by inflammation of the airways.


Commonly referred to as steroids, corticosteroids are a type of anti-inflammatory drug. They are typically used to treat rheumatologic diseases, like rheumatoid arthritis, lupus, or vasculitis (inflammation of the blood vessels). If you have (COPD), your doctor may prescribe inhaled corticosteroids as part of your treatment. Steroids can help control inflammation and swelling in your airway.


Mild to moderate exacerbations of COPD are usually treated with older broad-spectrum antibiotics. Preventing respiratory infections is critical to maintaining stable COPD conditions. Antibiotics fend off germs that can be harmful to the lungs. Antibiotics have also previously demonstrated anti-inflammatory properties, and they have been linked to therapeutic benefits in several pulmonary conditions that feature inflammation.

Oxygen Therapy

Oxygen therapy requires supplemental oxygen to assist COPD patients with breathing. Tanks or oxygen concentrators deliver a steady or pulse flow of oxygen to keep airways open and patient breathing consistent. Oxygen is measured via blood oxygen levels to ensure oxygen is saturating throughout the bloodstream and into the body’s tissues.

Where Can I Buy Equipment for Oxygen Therapy?

You can buy oxygen concentrators from the comfort of your home online at The Oxygen Concentrator Supplies Shop. Our knowledgeable staff can answer all your questions about the best oxygen equipment for your therapy. Call us at 888-941-1688.

Chris Vasta

Chris Vasta is the president of The CPAP Shop and an expert in sleep and respiratory therapy. He often provides insights on product design and functionality on various manufacturers’ prototypes and is frequently tapped to provide reviews on new releases.