COPD Flare-Ups

Download our COPD Flare-ups – What You Need to Know

A COPD flare-up (or an exacerbation) can be scary for both the person living with COPD and his or her caregiver. Sometimes COPD flare-ups can be minor, but sometimes they can be severe. It’s important to know what a flare-up looks like and how to respond. This resource is designed to help people living with COPD know how to prevent a flare-up, prepare for a flare-up and respond to a COPD flare-up.


Review the signs of a flare-up

It is important to know how to recognize the signs of a flare-up. Below is a list of things to look for:

  • An ongoing or more severe cough;
  • A cough that produces a lot of mucus;
  • Increased shortness of breath, especially with physical activity or when resting;
  • Wheezing or a whistling or squeaky sound when breathing;
  • Chest tightness;
  • Cold or flu-like symptoms.


Know how to prevent a flare-up

Early detection is important, be aware of the signs and symptoms above, call your doctor at the first sign of a change to your baseline health. You should also:

  • Avoid others that are sick, when able;
  • Practice good hand washing;
  • Speak to your doctor about proper nutrition and pulmonary rehabilitation;
  • Seek out information to help you or your loved one stop smoking;
  • Get the proper vaccines (e.g., flu and pneumonia vaccines).



Know how to prepare for a flare-up

Even with the best prevention practice, a flare-up may still occur. It is important to focus on planning. Being prepared will help you and your caregivers know what to do in the event of a flare-up:

  • Speak with your health care provider to determine the best medications for a flare-up;
  • Know your triggers and avoidance strategies (e.g. make your home smoke-free, treat allergies, etc.);
  • Keep your medication lists current and on hand at all times;
  • Know the locations of emergency rooms or urgent care facilities and identify a Power of Attorney (POA);
  • Prepare your home with a stock of food, water, medications and medical device supplies.


Know how to respond to a flare-up

  • Track and review signs and symptoms; identify when a symptom is not normal or may be an emergency (i.e., chest pain, fever, shortness of breath not subsiding with rest, etc.);
  • Contact your doctor;
  • Have your current list of medications on hand;
  • Communicate well with caregivers;
  • Use a COPD action plan and share it with your caregivers and doctors.


If you are experiencing a COPD emergency, which may include symptoms such as fast or irregular heartbeat, difficulty walking or talking, breathing fast and hard, call 911 immediately.

Oxygen Therapy for COPD

Download the Oxygen Therapy – What You Need to Know PDF.


There are changes that occur in the lungs of Chronic Obstructive Pulmonary Disease (COPD) patients. Two large changes are:

  • Narrowing of the airways
  • Damage of lung tissue

These changes make it harder for patients to breathe. The amount of oxygen that reaches the blood is not enough to meet the body’s needs. Oxygen therapy can help control this problem.

Signs and symptoms

There are signs and symptoms that should alert patients to the possibility of needing supplemental oxygen and may prompt them to visit a healthcare provider. These signs and symptoms are:

  • Shortness of breath
  • Decreased exercise tolerance
  • Fatigue and dizziness

Testing oxygen levels

Your healthcare provider will be able to tell if someone needs supplemental oxygen by testing the blood oxygen level.

Benefits of oxygen

More than 15 hours per day of oxygen therapy in patients with chronic respiratory failure has been shown to increase survival and improve quality of life. Oxygen therapy also improves exercise capability, sleep, and mental performance.

Types of oxygen systems

Oxygen concentrator

  • The most commonly used system at home.
  • It produces oxygen by concentrating the oxygen that is already in the air and eliminating other gases.
  • A portable version is available that allows user flexibility outside of the home.

Compressed oxygen cylinders

  • Small enough to be carried in small side packs.
  • Weigh less than eight pounds.

Liquid oxygen systems

  • Allows larger amounts of oxygen to be stored in smaller, more convenient containers than compressed oxygen.
  • Cannot be kept for a long time because it will evaporate.


This content is provided for informational purposes only and does not substitute for medical advice.


Download the Nebulizers – What You Need to Know PDF.


Nebulizers are small air compressors used to administer medicine. Users put a nebulizer mask on their face or use a mouthpiece to breathe in mists of air mixed with medicine. Nebulizers do not require oxygen tanks; they use the air in the room.

Who should use a nebulizer?

A health care provider may recommend a nebulizer for a variety of reasons. Nebulizers are often prescribed for infants and children who are not coordinated enough to use an inhaler. Also, the liquid vials of medicine used with nebulizers can be less expensive than purchasing the same medicine in an inhaler.

However, nebulizers are not always the best option for someone with asthma. They are not as portable as inhalers, so someone who only has a nebulizer may not have easy access to their medicine if their asthma acts up away from home. Some asthma medicines are also not available for nebulizers.

How do I use a nebulizer?

If you are prescribed a nebulizer, follow these steps carefully:

  1. Wash your hands.
  2. Open the medication cup and fill it with medication as prescribed by your health care provider.
  3. Secure the cap.
  4. Attach either a mouthpiece or mask to the end of the medication cup.
  5. Hook one end of the tubing to the medication cup and the other end to the nebulizer.
  6. If using a mouthpiece, seal lips tightly around the mouthpiece. If using a mask, place mask firmly on the face.
  7. Turn on the nebulizer. Breathe normally through the mouthpiece or mask. Continue until you no longer see the medication mist (about 10 minutes).

Care and cleaning of a nebulizer

It is very important to clean your nebulizer to prevent infections.

  • Always wash your hands prior to touching medicine.
  • After each use, remove the medication cup and rinse with warm water. Place on a paper towel and allow to air dry.
  • Once a week, clean medication cup in mild soapy water or one part vinegar and two parts water. Rinse well and place on a paper towel to air dry.
  • Replace the nebulizer cup and tubing every six months.
  • Change the filter in your nebulizer when it becomes discolored.
  • Never wash or clean the tubing because mold can grow inside.

Dry Powder Inhalers

Download the Using a Dry Power Inhaler – What You Need to Know PDF.


Using a Dry Powder Inhaler (DPI or Diskus®)

Dry powder inhalers (DPIs) are a type of long-term controller medicine. This type of medicine can be prescribed to help reduce the frequency of asthma symptoms. It works slowly to reduce swelling in the airways, which is an underlying cause of asthma symptoms.

Directions on how to use your dry powder inhaler:

  1. Remove all candy, food or gum from your mouth.
  2. Stand up straight.
  3. Hold the inhaler level to the floor.
  4. Open the inhaler with the mouthpiece facing you.
  5. Slide the lever away from you until you hear it click. This means the medicine has been released. Be careful not to tip the inhaler or slide the lever again; the medicine will fall out and it will be wasted.
  6. Take a deep breath in and breathe out.
  7. Place the inhaler in your mouth, seal your lips tightly around it and take a quick, deep breath in.
  8. Hold your breath for 10 seconds, and then breathe out.
  9. Rinse your mouth with water and spit water out.

Helpful tips for use:

Because this medicine is a dry powder, moisture can ruin the medicine and cause it to clump.

  • When preparing to take a dry powder inhaler, be sure not to breathe into the inhaler.
  • Do not store in the bathroom.

Metered Dose Inhalers

Download the Using a Metered Dose Inhaler – What You Need to Know PDF.


Metered dose inhalers (MDIs) can contain long-term controller medicine or quick-relief medicine. It is important to know which medicine your inhaler contains because the two types of medicines work on different parts of asthma.

Spacers (holding chambers)

Whenever possible, use a spacer (also known as a “holding chamber”) with your metered dose inhaler. A spacer is a plastic tube that connects to the mouthpiece of an inhaler and helps get medicine deeper into the lungs and airways.

A spacer helps direct the medicine to the airways so that each dose of medicine is more effective and less medicine is wasted.

Using a metered dose inhaler with a spacer:

  1. Remove any candy, food or gum from your mouth.
  2. Stand up straight.
  3. Remove the cap of the inhaler and attach it to the spacer. Make sure to clean out any dust or fuzz so that there is nothing inside either one.
  4. Shake the inhaler and spacer for five seconds.
  5. Take a deep breath in and breathe out slowly to empty your lungs completely.
  6. Put the spacer in your mouth and seal your lips around the mouthpiece.
  7. Press down on the inhaler and take a slow deep breath in.
  8. Hold your breath for 10 seconds and then breathe out.
  9. If using a controller medicine, rinse your mouth with water and spit water out.

Using a metered dose inhaler without a spacer:

  1. Remove any candy, food or gum from your mouth.
  2. Stand up straight.
  3. Remove the cap of the inhaler and attach it to the spacer. Make sure to clean out any dust or fuzz so that there is nothing inside either one.
  4. Shake the inhaler and spacer for five seconds.
  5. Take a deep breath in and breathe out slowly to empty your lungs completely.
  6. Place the inhaler mouthpiece inside your mouth and seal your lips tightly around the mouthpiece.
  7. Take a slow breath in, press down on the inhaler and breathe in the medicine.
  8. Hold your breath for 10 seconds and then breathe out.
  9. If using a controller medicine, rinse your mouth with water and spit water out.

COPD Medications

Download the COPD Medications PDF.

What are COPD medications used for?

Since COPD is usually progressive, regular treatment options should be ongoing unless significant side effects occur. Medication plans are introduced based on the level of COPD severity and symptoms. Your provider will prescribe medication as part of your treatment plan.

COPD treatment consists of medication and non-medication therapies. Medications are used to:

  • Prevent and control symptoms
  • Reduce the frequency and worsening of COPD symptom
  • Improve your breathing
  • Improve your ability to exercise


The following classes of medications are commonly used in treating COPD. While we have tried to provide multiple examples, the landscape of medications changes on a regular basis and we encourage you to contact your provider to determine what medication plan is best for you.

Inhaled Bronchodilators

  • Help relax tight muscles around the airways
  • Taken either on an as-needed basis for relief of symptoms or on a regular basis to prevent or reduce symptoms

Examples: Fast- or long-acting beta-2 agonists (Ventolin, ProAir), anticholinergics (Atrovent, Incruse Ellipta, Spiriva Respimat) and/or combination bronchodilator therapy (Anoro Ellipta, Stiloto Respimat)

Inhaled Corticosteroids

  • Help reduce the frequency of exacerbations (flare-ups) by reducing inflammation in the airways
  • Recommended for patients with more advanced COPD and repeated exacerbations

Examples: Inhaled corticosteroid (Arnuity® Ellipta®) and combination corticosteroidbronchodilator therapy (Breo® Ellipta®, Advair®, Symbicort®)

Oral Corticosteroids

  • Help reduce inflammation during an exacerbation (flare-up)
  • Long-term treatment not recommended

Examples: Prednisone or methylprednisolone

PDE 4 inhibitors

  • Chronic medication that reduces hospitalizations and flare ups related to COPD. Used as an add-on medication to long-acting inhalers

Examples: Roflumilast


  • Chronic medication used to help decrease shortness of breath
  • Interacts with many medications

Examples: Theophylline


This content is provided for informational purposes only and does not substitute for medical advice.

What is COPD?

Download the What is COPD – What You Need to Know PDF.


Chronic obstructive pulmonary disease (COPD) is a combination of lung damage and mucus buildup that makes it hard to breathe. It can include chronic bronchitis, emphysema or both. There is no cure for COPD, but it can be managed and the progression of the disease can be slowed.

COPD is the third leading cause of death in the U.S. Half of all people with COPD are not diagnosed. Talk to your health care provider if you have symptoms of COPD.

What are the symptoms of COPD?

In the early stages of COPD, there may be no noticeable symptoms and COPD may worsen over time. Signs and symptoms vary and may include:

  • Shortness of breath
  • Chronic cough with or without mucus
  • Wheezing
  • Chest tightness

What causes COPD?

COPD is caused by damaged lung tissue and/or mucus buildup that makes it hard for the lungs to absorb oxygen and carry it to the rest of the body. The most common cause of COPD is smoking. Long-term exposure to other lung irritants, pollution, chemical fumes or dust, may also lead to the disease.

How is COPD diagnosed?

COPD is diagnosed with a breathing test. This test will take measurement of the amount of air you are able to breathe in and out of your lungs. This test will help diagnose COPD. Once COPD is diagnosed, your healthcare provider can work with you to determine an action plan to control your COPD.

Because COPD worsens over time, it is important that it is diagnosed early to manage symptoms before they become severe. People who may need a breathing test for COPD include:

  • People who smoke or smoked in the past
  • A history of exposure to lung irritants
  • A family history of the disease
  • Are experiencing symptoms

What can you do to manage COPD?

Quitting smoking is the most important way to lessen COPD symptoms. Also, reduce your exposure to strong odors such as perfume and home cleansers, dust, fumes, gases and indoor/outdoor air pollution.

Other ways to manage COPD include:

  • Exercising
  • Taking medications
  • Oxygen therapy
  • Pulmonary rehabilitation
  • A lung transplant

Talk to a health care provider to see what’s right for you.

Alpha-1 Antitrypsin (AAT) Deficiency

Download the Alpha-1 Antitrypsin (AAT) Deficiency – What You Need to Know PDF.


Alpha-1 Antitrypsin (AAT) Deficiency is a hereditary condition that causes your body to lack or produce low levels of this protective protein that protects the lungs. If inherited, AAT deficiency can lead to chronic obstructive pulmonary disease (COPD).

Symptoms of AAT Deficiency

  • Shortness of breath
  • Cough and/or sputum production
  • Wheezing and recurring chest colds
  • Jaundice (yellowing of the skin)
  • Abdominal swelling and/or gastrointestinal bleeding
  • Unexplained liver problems

Who should be tested?

All people with a diagnosis of COPD should be tested for AAT deficiency. In addition, people with a diagnosis of asthma whose breathing tests do not return to normal after inhaling a bronchodilator should be tested for AAT deficiency. People with a family history of AAT deficiency, emphysema or liver disease at an early age, adult-onset asthma, or recurrent bronchitis should also be considered for testing. Testing is quick, easy, and highly accurate with a simple finger stick.

Treatment for AAT Deficiency

The highest priority for those with AAT deficiency is to quit smoking. Treatment should include scheduled flu and pneumonia vaccines and continued use of prescribed inhaled medications to improve lung function. Your provider may recommend a pulmonary rehabilitation program. Additional therapies may be needed to decrease loss of lung function. Your health care provider will discuss treatment options for AAT with you if you are found to be AAT deficient. A lung transplant may also be an option for those with severe disease.

Talking with your family

People with this condition should talk with their family members and encourage them to be tested. Although others may not test positive for this disease, they may be carriers. Genetic and psychological counseling can provide knowledge and support for those families who have been affected by the disease.

Recommendations for those with AAT Deficiency

  • Avoid all of the following: tobacco smoke, environmental and work pollutants, wood-burning stoves, fumes from household cleaning products, and paints and/or other toxic agents
  • Maintain regular medical appointments
  • Take medication as directed and listen advice from your healthcare provider
  • Stay current with immunizations (vaccines)
  • Follow a good nutrition and exercise program
  • Reduce alcohol use
  • Develop a stress management program
  • Avoid exposure to people who are sick
  • Participate in pulmonary rehabilitation if recommended by your care provider


Download the Spirometry – What You Need to Know PDF.


Spirometry is a noninvasive breathing test that determines how well a person’s lungs are working. This test is done with a device called a spirometer.

A spirometer measures both the amount of air and how fast a person can blow it out of their lungs. This test is able to detect very small changes in breathing before a person would be able to. The test takes only a couple of minutes, no needles are involved, it is not painful and patients do not have to remove any clothing.

How does it work?

The person being tested is asked to breathe in fully, seal their lips around a mouthpiece, then blow out as hard, fast, and long as they can, usually about six seconds. A nose clip may be applied to ensure no air escapes from the nose.

What does a spirometry test measure?

A spirometry test measures airflow over time. The test provides two values which are helpful in determining the results, forced vital capacity (FVC) and forced expiratory volume measured over one second (FEV1). FVC is the total amount of air that can be blown out and FEV1 is the flow of air during the first second of the test. FEV1 divided by FVC determines the proportion of air in a person’s lungs that can be blown out in one second.

What do the results tell us?

The results from a spirometry test help determine if a person has any airflow problems that could be the result of COPD, asthma or restrictive lung disease. The results from this test can also identify smokers who are developing COPD and evaluate the effects of workplace exposure to lung irritants.

Who should be tested?

  • Current and former smokers
  • People 40 years of age and older
  • Anyone exposed to fumes, vapors, dust, or other lung irritants

Also, anyone who has:

  • A chronic cough
  • Pain, difficulty or wheezing while breathing
  • Fatigue or shortness of breath at rest, during light exercise or everyday activities
  • Restless sleep, snoring or sleep apnea
  • Weight loss, heart failure, fever, chills or osteoporosis
  • Are there any side effects?

Spirometry has very few side effects and is a very low risk test. When taking the test, a person may experience dizziness. Blowing out hard may cause an increase in pressure in the chest, abdomen, or eye.

People with unstable angina or anyone who had a recent heart attack or stroke are advised not to have a spirometry test. It is also recommended that anyone who recently had air trapped beneath the chest wall (pneumothorax) or recent eye or abdominal surgery should not have a spirometry test.