Signs of a flare-up of COPD and what to do

Managing my COPD
NHS GGC

A flare-up or exacerbation of COPD is when you experience a sudden change to your normal daily symptom pattern.  

A flare-up can be triggered by several different things including a respiratory virus or bacteria that results in a chest infection, changes in the weather or heightened levels of stress and anxiety. Not all exacerbations are caused by infections, so it is good to know what your specific triggers are and try to avoid them. 

Warning signs of a flare-up  

Warning signs of a flare-up of COPD include: 

  • worsening breathlessness 
  • new or increased cough 
  • chest tightness or wheeze 
  • change in the colour, consistency or volume of sputum 
  • having a temperature or feeling feverish 
  • increased fatigue 
  • reduced appetite

Recognising the warning signs   

Early recognition of the warning signs of a flare-up prevents symptoms from getting worse and helps you recover quicker. It can also prevent further lung damage and reduce the chances of hospital admission. 

To recognise the warning signs of a flare-up you must firstly get to know how your COPD affects you on a day-to-day basis and what your usual symptoms are.  
 
For example:  

  • how far can you normally walk before you have to stop to catch your breath? 
  • how often do you cough?  
  • how much sputum do you normally cough up and what colour is it? 
  • how wheezy or tight does your chest normally feel? 
  • how much energy do you normally have? 

 
Completing daily symptom questions or a symptom diary can help you to answer some of these questions and understand your normal. This will allow you to recognise more quickly when your symptoms change.

Look at Traffic lights for COPD below for advice if you do notice any changes.

Traffic lights for COPD

The traffic lights system is a self-management tool for COPD to help you monitor your own symptoms, and advises what to do as soon as you notice your symptoms getting worse.  

The traffic lights system consists of 3 zones; GREEN, AMBER and RED.

GREEN ZONE

When you are in the green zone, your symptoms are under control, and you feel that your symptoms are at their usual baseline level. You should continue with your usual medication, chest clearance and exercise as normal, within your limits.  

 

AMBER ZONE

When you are in the amber zone, you feel your symptoms are getting worse and you are not at your usual level.

You don’t feel ok.  

You may feel like: 

    • You are using your blue (reliever) inhaler more often and it is not helping 
    • You are more short of breath and more wheezy than normal
    • You have a new cough or are coughing more than usual
    • You sputum has changed colour and looks greener  
    • You have new or worsening ankle swelling
    • You have less energy and feel more tired
    • Your appetite is less than normal 

These changes may mean you are developing a flare up or exacerbation of your COPD.  

You should: 

    • use more of your blue reliever inhaler
    • rest more often
    • use breathing techniques and chest clearance exercises
    • drink plenty of fluids
    • eat small amounts often  
    • continue your usual medications

Keep monitoring how you feel. If your symptoms improve, continue with your usual medications and your breathing and chest clearance exercises as normal. If your symptoms do not improve after 24-48 hours, it's time to seek medical assistance. Go to the instructions for the RED ZONE.

  

RED ZONE

If there is no improvement in your symptoms in 24-48 hours then you are in the red zone.  

You should contact you GP or NHS 24 (if out of hours) by dialling 111.

If you feel too unwell to wait for the doctor or nurse to phone you back, dial 999.

You may need to start mediation in your rescue pack if you have one from your GP.

If you have rescue medication at home:

    •  start your home supply of antibiotics if your sputum has increased or changed colour
    •  start your home supply of steroids (prednisolone) if you are significantly more breathless, have new or increased wheeze, or new chest tightness. 

When you are in the RED ZONE and need to be looking out for the following more serious symptoms: 

    • You are extremely breathless or have difficulty breathing
    • You feel drowsy or confused
    • You have chest pain
    • You have a high temperature 

If you have any of these symptoms and/or you are not feeling better after 48 hours of taking rescue medications, you must contact your GP/NHS 24 or call 999 for an ambulance in an emergency.

The information about Traffic Lights for COPD is also viewable in this video from the NHSGGC Community Respiratory Team. 

Click here Click here to download the Chest Heart and Stroke Self-Management Plan