What is a flare-up?
A flareup (also called an exacerbation) occurs when your COPD symptoms quickly become worse and stay worse for at least one or two days.
Common signs of a flare-up
- More coughing than usual
- Coughing up more phlegm, phlegm is a different colour
- More breathlessness, wheezing
- Fatigue
What do I do if I have a flareup?
Learning how to lower your risk of a flareup and managing them when they do occur is a big part of managing your COPD. It’s important that you speak to your care team about how to recognize a flareup and what to do when and if you have one. Work with your care team to create a COPD Action Plan.
You can treat many flareups at home, especially if caught early. Your provider may prescribe a fast-acting or “rescue” inhaler for you to use when you have a flareup. This will dilate (expand) your airways to make it easier for you to breathe.
You may also need to take steroid pills for several days to help quickly reduce the swelling in your airways. Corticosteroids slow or stop the immune response that is causing your airways to swell.
These are examples of fast-acting medications. You may also use a long-acting inhaler every day even if you feel well to help prevent flareups and manage your COPD. This inhaler contains a bronchodilator and may also include steroid medication. These are different from the inhaler and steroids used to help your breathing improve during a flareup.
Your provider may prescribe antibiotics for you to take if you suspect the flareup is being caused by a chest infection.
If your flareup is more serious, if you experience frequent flareups or if you have other conditions that affect your health, you may have to visit your doctor or even go to the hospital. Among Canadians over 65, COPD is the third-leading cause of hospital admission.
Use your COPD Action Plan
A COPD Action Plan is a personalized plan that you create with the help of your doctor and COPD care team. You can use your plan to record what “normal” feels like for you so that you can tell when you’re experiencing a flareup. You can record the medication you take every day to stay well, and what medication to take in the case of a flareup.
Your action plan will help you recognize the signs of a flare-up so that you’re able to treat the flare-up early. By preventing your flare-up from getting worse, you are more likely to avoid a visit to the emergency room.
Action plans are typically divided into three sections:
- a green section where you record what “normal” is for you,
- a yellow section will list signs of a bad day that could indicate a flareup and what you should do when this occurs, and
- a red section will help you identify when you need urgent medical attention.
What can I do to prevent or reduce flareups?
One of the main goals of treatment of COPD is to prevent flareups from occurring. There are many things that you can do to help manage your COPD and reduce your risk of flareups.
Learn about your COPD
Learn about COPD and what you can do to keep yourself as healthy as possible. Learn what triggers your COPD and what “normal” is for you and record this as part of your COPD Action Plan.
Quit smoking
Smoking is the number one cause of COPD. Smoking can cause flareups and over the longer term, can cause your COPD to progress faster because of the ongoing damage to the lungs.
Get vaccinated
Because respiratory infections are a major cause of COPD flareups, it’s important that you stay up to date on your vaccinations for flu, COVID-19, pneumonia and respiratory syncytial virus. You should also practice proper handwashing, avoid crowds and wear a mask if you will be in close contact with others.
Stay active
Exercise is very important if you have COPD. It helps your muscles work more efficiently and makes your lungs stronger. It can help you maintain a healthy weight and give you more energy.
Eat healthy
Healthy eating not only helps prevent obesity but it also provides your body with the energy it needs and supports your immune system. Certain foods also have anti-inflammatory properties. In later stages of COPD when weight loss is common, it’s even more important that your body receives the nutrition it needs to prevent additional comorbidities and frailty.
How and why you should exercise
When you have COPD, it’s easy to avoid being active. In fact, exercise is one of the best things you can do to manage your symptoms and improve your wellbeing.
The cycle of inactivity
Avoiding activity can lead to a cycle of weaker muscles, more breathlessness, further avoiding activities that could cause breathlessness and worsening of COPD symptoms. This is called the Cycle of Inactivity.
The cycle of activity
By exercising regularly, you can break this cycle and create a new cycle, the Cycle of Activity, in which exercising becomes easier and helps you feel better, which motivates you to continue exercising.
The benefits of exercise
Do more with less effort
As you become less physically active, your muscles (including your heart) become less efficient and have to work harder. This can leave you tired and breathless. Regular exercise can help your lungs, heart and other muscles work more efficiently.
Reduce the severity and number of flareups
Exercise makes your lungs stronger. It also makes your immune system stronger, improving your body’s ability to fight off infections.
Maintain a healthy weight
Regular exercise can help you reach and maintain a healthy weight, which can help make it easier for you to breathe. It also can help prevent muscle wasting that occurs in later stages of COPD.
Improve your quality of life
It can increase your energy level, reduce feelings of anxiety, depression or stress and help you maintain or regain your independence.
Pulmonary rehabilitation
Pulmonary rehabilitation is a supervised, multi-week program that helps people who have lung diseases like COPD to live and breathe better through exercise, education and support. It’s an excellent way to help you stay active and learn how to manage your disease.
Participants must be referred to a PR program, which is typically offered by a hospital, with sessions being held at the hospital or at local recreation or community health centre.
Our at-home education and exercise program
The demand and need for PR far exceeds the number of spaces in programs across Canada. It can be difficult to access a local program (if there is one nearby) due to waiting lists, lack of transportation or inability to take time off work.
The Canadian Lung Association offers a free, online program of exercise and education called BreatheSTRONG that can be done by anyone in the comfort of their own home. It is a great way to maintain regular physical activity following pulmonary rehab or can be done as you wait for a spot in an in-person program.
Before you begin
Before you start any exercise program, check in with your doctor or other healthcare provider. Ask them:
- What type of exercise program would be best for me?
- What do I need to know about using my medications before, during and after exercise? Should I use my inhaler before I exercise?
- What should I do if I start to feel out of breath?
Make sure you are familiar with breathing and coughing techniques that can help you as you are exercising.
Simple walking is one of the best ways to increase your fitness level. Start slow and gradually do a little more or work a little harder as you become stronger. Remember, any amount of exercise is better than no exercise and small steps are better than no steps.
10 tips for a successful exercise plan
1. Set personal goals
Work with your COPD team to establish goals that are reasonable for you and develop an exercise plan that is tailored to your fitness level and breathing ability.
2. Build up slowly
Do not push too hard but try to go a little further or exercise a little longer every few days. This will increase the efficiency of your body and your muscles.
3. Have fun
Find an activity you enjoy. You will be more likely to keep going if exercise feels more like fun than work. Consider activities like aquafit, dancing, yoga or even walking with a friend. If you have more fun alone, watch a movie or listen to a podcast or music while you exercise. Of course, be sure you are staying safe and aware of your surroundings.
4. Alternate activities
When you have COPD, you need strength in all your muscles. However, you may not be able to exercise all your muscles at once. Try exercising your arm muscles one day and your leg muscles the next to get a complete workout without tiring yourself out.
5. Schedule wisely
Exercise when you know your energy level will be high; maybe shortly after taking your medication. Do not exercise on a full stomach − try before a meal or an hour or two after eating. Once you figure out what works best for you, treat your exercise time like an appointment. Organize your day around it. Do not start wondering if you have enough time to exercise — that will make it easier to find an excuse not to. Eventually exercising will become a part of your routine.
6. Listen to your body
If you are overtired or feeling sick, you may need to limit your exercise for that day. If you have a big event one day, think about limiting your usual time, or postponing your exercise until the next day.
7. Dress for comfort
Wear loose-fitting clothing. Dress in layers, so you can take off a sweater if you get too hot. Choose shoes that fasten easily and offer good support as well as ample cushioning.
8. Watch weather and pollution
Avoid exercising outdoors if pollution levels are high or the weather is too cold, too hot or too humid. If possible, plan to exercise indoors on those days.
9. Treat yourself
To stay motivated, give yourself a little reward after exercising.
10. Exercise regularly
Make fitness a priority and set aside specific times during the week to exercise. Aim for at least three times per week. Remember, if you do have to stop exercising due to illness or another reason, do not get discouraged. Start again slowly when you are able. You will gradually regain your muscle conditioning.
What is a comorbidity?
Having a comorbidity means that you have more than one disease or condition at the same time. Co-morbidities are common for people with COPD. When organs in the body don’t receive enough oxygen because of COPD, it can affect the way they work and put your health at risk.
COPD is associated with many comorbid conditions and most people with COPD have at least one, sometimes more of these conditions at the same time. Sometimes these conditions are related to COPD (a complication of COPD); sometimes these conditions would have occurred whether or not an individual develops COPD.
Comorbidities can make it more difficult for you to manage your COPD. They can also increase your risk of hospitalization and death. It is important that your doctor considers any comorbidities you may have when determining the severity of your COPD and before recommending treatment. Co-morbidities are common for people with COPD. Comorbidities can make it more difficult for you to manage your COPD and increase your risk of hospitalization.
Common comorbidities for people with COPD
- cardiovascular (heart) disease
- obesity (mild to moderate COPD)
- osteopenia (loss of bone density)
- osteoporosis (weakened bones, more likely to fracture)
- glaucoma and/or cataracts
- weight loss and malnutrition (severe COPD)
- peripheral muscle dysfunction (fatigue, weakness, loss of muscle mass)
- cancer
- anxiety and depression
- metabolic syndrome (high blood pressure, high blood sugar, excess abdominal fat, high cholesterol) and diabetes
- sleep disturbance
A note about obesity and COPD
Obesity is a risk factor for COPD. COPD can also make it more difficult to maintain a healthy weight: if you have COPD, breathing problems make it difficult to exercise. This, in turn, can lead to further weight gain and worsening of COPD symptoms. Both COPD and obesity are risk factors for heart disease. Symptoms of heart disease can be made worse by COPD and obesity.
Obesity is more common in people with mild to moderate COPD. Weight loss can occur in cases of more severe COPD. “COPD wasting” occurs when a person loses muscle mass and may become malnourished. Individuals with severe COPD who are underweight are at greater risk of death than those with COPD who are not underweight.
Resources from CLA
BreatheSTRONG exercise and education program
Other resources
Living Well with COPD (Respiplus)
Quit Map (Canadian Cancer Society)
Find in-person, online or phone services in your area to quit smoking or vaping