Chronic Obstructive Pulmonary Disease (COPD): Managing Flare-Ups and Daily Life

What COPD is, in brief

In COPD the airways are inflamed and narrowed (chronic bronchitis) and the walls of the air sacs break down (emphysema). Air gets in but cannot get out easily, so the lungs become over-inflated and each breath takes more effort. The damage builds over years, usually after decades of smoking, and is diagnosed with spirometry: a breathing test in which the ratio of air blown out in 1 second (FEV1) to the total blown out (FVC) is below 0.7 after a bronchodilator.

This page focuses on day-to-day management. For staging, the full list of treatments and life expectancy, see our main COPD overview. Emphysema has its own page too.

Early signs of COPD

• Getting out of breath on stairs or hills sooner than people your age
• A "smoker's cough" with phlegm most mornings
• Chest colds that last weeks or keep coming back each winter
• Wheezing or a tight chest

Anyone over 35 who smokes or used to smoke and has these symptoms should ask for spirometry. Many people lose half their lung function before they are diagnosed.

COPD flare-ups: how to spot and handle them

A flare-up, or exacerbation, is a period when symptoms get clearly worse than your usual day-to-day variation, usually over 1 to 14 days. Most are triggered by a cold, flu, COVID-19, RSV or a bacterial chest infection. Air pollution and cold air also play a part. Each serious flare-up can permanently reduce lung function, so early treatment matters.

Warning signs

• More breathless than usual for 2 days or more
• More phlegm, or thicker phlegm
• Phlegm changing color to yellow, green or brown
• More cough or wheeze, or disturbed sleep

Your action plan

Ask your doctor for a written COPD action plan. It typically says:

1. Use your rescue inhaler more often, as directed.
2. Start a "rescue pack" (a short course of oral steroids, and antibiotics if your phlegm has changed color) if your doctor has given you one, and tell your care team within 24 hours that you started it.
3. Use breathing control and positioning techniques (below).
4. Call 911 or your local emergency number if the red-flag signs above appear.

After any flare-up, book a review. Doctors use it to check inhaler choice and technique and to look for patterns.

Inhalers: getting the most from them

Most people with COPD use one or more long-acting inhalers every day, plus a short-acting rescue inhaler.

Current guidelines usually start with a LAMA plus LABA combination. A steroid is added mainly for people who still have flare-ups and have raised blood eosinophils. Steroid inhalers slightly raise the risk of pneumonia, so they are not used for everyone.

Common inhaler mistakes

• Not breathing out fully before inhaling
• Breathing in too fast with a spray inhaler (it should be slow and steady) or too gently with a dry-powder inhaler (it should be quick and deep)
• Not holding the breath for up to 10 seconds afterwards
• Forgetting the spacer with a metered-dose inhaler
• Not rinsing the mouth after a steroid inhaler, which can lead to thrush

Ask a pharmacist or nurse to watch you use your inhaler at least once a year. Poor technique is one of the commonest reasons treatment seems not to work.

Breathing techniques for breathlessness

• Pursed-lip breathing: breathe in through your nose for 2 counts, then out slowly through pursed lips (as if blowing out a candle) for 4 counts. This keeps airways open longer and reduces trapped air.
• Forward-leaning positions: sitting and leaning forward with forearms on your thighs or a table, or standing leaning on a counter, helps the diaphragm work.
• Paced breathing on activity: breathe out during the effort part, such as lifting or stepping up.
• Airway clearance: the active cycle of breathing technique, or a handheld device, helps people with lots of phlegm clear it.
• A handheld fan blowing cool air on the face eases the feeling of breathlessness.

Pulmonary rehabilitation

Pulmonary rehab is a supervised program, usually 6 to 12 weeks, combining exercise training, breathing techniques and education. It improves breathlessness, exercise capacity and quality of life more than most medicines, and reduces hospital readmission when started soon after a flare-up. Ask for a referral if breathlessness limits your daily activities.

Oxygen and other treatments

• Long-term oxygen helps people whose blood oxygen stays low at rest. It must be used for at least 15 hours a day to extend life. It is not given just for breathlessness when oxygen levels are normal. Never smoke or allow open flames near oxygen.
• Home non-invasive ventilation (a mask machine at night) can help people who retain carbon dioxide after a hospital stay.
• Roflumilast, long-term azithromycin or biologic injections may be used for frequent flare-ups in specific situations.
• Lung volume reduction (surgery or valves) or a lung transplant are options for selected people with severe emphysema.

Everyday life with COPD

Stopping smoking

Quitting is the only thing proven to slow the decline in lung function at every stage. Combining nicotine replacement or prescription medicines with counseling more than doubles success rates. Call 1-800-QUIT-NOW in the US for free support.

Vaccines

Get a yearly flu vaccine, keep up to date with COVID-19 and pneumococcal vaccines, and ask about RSV vaccination (recommended for older adults with chronic lung disease) and Tdap if you have not had a pertussis booster.

Nutrition and weight

Breathing hard burns calories, and many people with advanced COPD lose weight and muscle. Smaller, more frequent meals help when a full stomach makes breathing harder. Being very underweight is linked to worse outcomes, so mention weight loss to your doctor.

Mood

Anxiety and depression are common and make breathlessness feel worse. Pulmonary rehab, talking therapy and, when needed, medication help.

Travel and air quality

Check air quality forecasts and limit time outdoors on high-pollution days. Before flying, ask whether you need a fitness-to-fly assessment, because cabin air has less oxygen.

Complications to watch for

• Chest infections and pneumonia
• Cor pulmonale (right heart strain), with ankle swelling
• Collapsed lung (pneumothorax), causing sudden sharp chest pain
• Osteoporosis from inactivity and steroid courses
• Lung cancer, which is more common in people with COPD

Frequently asked questions

What does a COPD flare-up feel like?

You become more breathless than usual, cough more and bring up more or thicker phlegm, sometimes yellow or green. You may wheeze, sleep badly and feel exhausted. Changes lasting 2 days or more, rather than a single bad hour, are a sign to start your action plan and contact your care team.

What is the best breathing technique for COPD?

Pursed-lip breathing is the most widely taught: breathe in gently through the nose, then breathe out slowly through pursed lips for about twice as long. Combined with leaning forward and pacing activity, it reduces air trapping and the panic of breathlessness.

Can you exercise with COPD?

Yes, and you should. Regular walking and strength exercises improve breathlessness and stamina. Some breathlessness during exercise is safe and expected. A pulmonary rehabilitation program teaches you how hard to push and is the safest way to start.

Does oxygen help everyone with COPD?

No. Long-term oxygen helps people whose blood oxygen is low at rest, measured by blood gas tests. If your oxygen levels are normal, oxygen does not ease breathlessness more than a fan or room air, and it carries fire risks.

Is COPD the same as asthma?

No. Both narrow the airways, but asthma usually starts younger, varies a lot and reverses well with treatment. COPD develops after years of smoke or dust exposure and is only partly reversible. Some people have features of both, and treatment is then adjusted.

Can COPD get better if I stop smoking?

Lost lung tissue does not grow back, but stopping smoking slows the rate of decline to close to that of a non-smoker, reduces cough and phlegm within months, and lowers the risk of flare-ups, heart disease and lung cancer.