Chronic obstructive pulmonary disease (COPD) is a long-term lung disease affecting at least 15 million American adults. It’s also the fourth leading cause of disease-attributed death. This makes ongoing treatment and the prevention of exacerbations imperative.

Even if you’re already being treated for COPD, it’s possible to experience an exacerbation, or acute flare-up of your condition. This may involve various symptoms of breathing difficulties, along with a possible need for emergency treatment.

Doctors previously diagnosed and treated a COPD exacerbation based solely on worsening of the cardinal symptoms. Newer guidelines reflect the complexity and variations in this lung disease. Read on to learn more about these diagnostic differences, and what you should do if you’re experiencing a possible COPD exacerbation.

Doctors previously diagnosed COPD exacerbations only by the worsening of three “cardinal,” or primary symptoms. These are:

  • Dyspnea describes shortness of breath and breathing difficulties.
  • Sputum volume is the amount of mucus in your airways. During an exacerbation, you’ll have more mucus production.
  • Sputum purulence describes the color and consistency of mucus you may cough up. In COPD, mucus is normally white or light yellow. Darker shades of yellow or green could indicate an infection.

If you have COPD, you may experience these symptoms regularly. Without treatment, these can get worse over time and impact your everyday activities.


Doctors previously used the Winnipeg criteria to stage a COPD exacerbation based on how many cardinal symptoms were present. The type reflected how severe an exacerbation was.

  • Type 1: all three cardinal symptoms are present
  • Type 2: any two of the cardinal symptoms are present
  • Type 3: one of the cardinal symptoms is present, along with an upper respiratory tract infection and fever, or increased wheezing, coughing, or heart rate

Doctors used the type of COPD exacerbation to help determine the best course of treatment. In particular, it helped doctors decide whether to prescribe antibiotics to manage symptoms.

Current practice

Doctors currently define COPD exacerbations as worsening symptoms that lead to additional therapy. This approach is more nuanced. Along with considering specific symptoms, it also considers when a person’s symptoms have changed enough to warrant a change in treatment.

People with COPD still experience cardinal symptoms, but these aren’t reliable on their own as diagnostic criteria. This is because these symptoms can be attributed to other conditions, such as congestive heart failure and pneumonia. Dyspnea, for example, is linked to multiple lung and heart diseases.

Exacerbations are also now staged as:

  • Mild: requiring an increase in current medication
  • Moderate: requiring corticosteroids, antibiotics, or both
  • Severe: requiring hospitalization

If you have COPD, you should have a care plan and action plan set up with a doctor. This helps you manage your regular symptoms, and also helps you know what to do in case of a flare-up. If you have a COPD exacerbation, you’ll need to see a doctor.

To treat and manage a flare-up, doctors treat the three physiological events responsible for them:

  • infection
  • inflammation
  • blocked airway

A moderate or severe COPD flare-up is often due to an infection. Doctors use antibiotics to eliminate the infection. You can expect to take these for 5 to 7 days.

The choice of antibiotic may depend on how many cardinal symptoms are present. Your doctor will also consider side effects and any possible resistance you may have to some antibiotics.

Some common antibiotics used include:

To lower inflammation, a doctor will prescribe a corticosteroid such as prednisone or hydrocortisone. This will help to wide your airways. Some steroids you inhale, but others you take by intravenous (IV) injection or a pill.

To relieve your blocked airways, your doctor may prescribe a quick-acting bronchodilator, such as albuterol or ipratropium, to help relax the tissue in your lung’s airways. These are usually taken with an inhaler or nebulizer.

Your doctor may also offer oxygen therapy to help you breathe more easily. In severe cases, you may need to be put on a ventilator to help you with the mechanics of breathing.

A COPD exacerbation may last several days or up to a month or longer. Severe flare-ups may require hospitalization.

Call 911 or local emergency services if you (or a loved one) are experiencing the following:

  • shortness of breath that’s so severe you can’t talk
  • shortness of breath that prevents you from lying down
  • severe chest pain
  • slurred speech
  • confusion
  • blue or pale lips and skin

How often do COPD exacerbations occur?

The exact frequency of COPD exacerbations may be unpredictable, but you may experience them more often depending on the classification of your condition. COPD itself is staged using the GOLD system. If you’re in GOLD group C or D, you’ve had more flare-ups or hospitalizations in the past year.

When do I need to see a doctor about a COPD exacerbation?

You should see a doctor right away if you think you’re experiencing a COPD exacerbation. If an exacerbation is left untreated, it could lead to further breathing difficulties that limit your daily activities. It can also lead to complications such as infection, high blood pressure, and heart problems.

Can I prevent COPD exacerbations?

While there’s no cure for COPD, treatment can help you manage your symptoms. You can also help prevent future exacerbations by avoiding triggers, such as air pollution, tobacco smoke, and chemical fumes.

Staying up to date on your vaccines can also help prevent infections that may lead to COPD flare-ups and complications. Talk with a doctor about regular flu and pneumonia shots, as well as the COVID-19 vaccine and booster doses.

A COPD exacerbation describes worsening symptoms that result in a need to change treatment. While you may experience the three cardinal symptoms, doctors now use broader criteria to properly diagnose a flare-up.

COPD is a progressive condition that may get worse over time. It’s important to follow your treatment plan and to help prevent triggers and infections that may lead to potentially life-threatening exacerbations.

Talk with a doctor right away if you’re experiencing worsening symptoms despite treatment. These could be indications of an exacerbation. If you have a history of exacerbations, work with a doctor to come up with a COPD action plan.

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