COPD GUIDE

COPD Exacerbation (Flare-Up): Diagnosis, Emergency Signs and Prevention

Prof. Dr. Yalçın Karakoca · Last updated: 25 September 2026

SHORT ANSWER

A COPD exacerbation (flare-up) is when your symptoms become clearly worse than usual. Shortness of breath, cough or phlegm increases. This worsening develops over a short time, within two weeks at most. It is most often triggered by a germ (a virus or bacterium). Polluted air can also trigger a flare-up. Mild flare-ups can be managed at home with the action plan you have prepared with your doctor. If shortness of breath makes it hard to talk, go to the emergency department immediately. Turning blue, confusion, chest pain or a high fever are also emergencies. Every flare-up can cause permanent damage to the lungs. Severe flare-ups can be life-threatening. That is why preventing flare-ups is at the centre of treatment.

Symptoms

Increased shortness of breath
More phlegm, with its colour becoming darker (yellow-green)
Increased coughing, wheezing
Fever, weakness, sleep problems
Needing your reliever medicine (fast-acting bronchodilator) more often

When should you go to the emergency department?

Can be managed at home	Call your doctor	112 / emergency
Mild increase; improves with reliever medicine	Phlegm has become thicker or turned yellow-green, you have a fever, or there is no improvement within 48 hours	Being unable to speak, turning blue, confusion, your oxygen reading falling 4 points or more below your usual value, chest pain, sudden swelling in the feet

Triggers

Flare-ups are most often triggered by respiratory viruses. Examples include flu, RSV, common cold viruses and COVID-19. Bacteria, polluted air and cigarette smoke can also lead to a flare-up. Very cold or very hot weather can also trigger one. Using medicines irregularly can also lead to a flare-up. Heart failure or a blood clot in the blood vessels of the lungs can also cause symptoms similar to a flare-up.

Flare-up action plan (prepared together with your doctor)

Use your reliever inhaler more often, as set out in your plan.
Note down your symptoms; measure your oxygen level.
If your plan includes it, start early on the steroid tablets your doctor has prescribed in advance (usually for 5 days). If your phlegm has turned yellow-green, start the antibiotic your doctor has also prescribed in advance.
If you use oxygen, do not exceed the flow rate on your prescription. The target oxygen saturation is usually 88–92%.
If there is no improvement within 48 hours, see a doctor.

Prevention

The main ways to prevent flare-ups are:

Vaccines (flu, pneumococcal, whooping cough, COVID-19; RSV at the appropriate age)
Using bronchodilator medicines regularly (together with a steroid inhaler if needed)
Staying away from cigarettes and smoke; hand hygiene
Pulmonary rehabilitation (it also reduces the risk of being readmitted to hospital after a flare-up)

In some people who have frequent flare-ups, additional medicines may be used. Roflumilast may be considered for those with cough and phlegm, and azithromycin for patients who have stopped smoking. Biologic medicines given by injection may be used in people with a high eosinophil count in the blood. Eosinophils are a type of white blood cell. In patients with a lot of phlegm, techniques for clearing phlegm (airway clearance) are important.

If symptoms continue despite medication

In COPD in which cough and phlegm predominate, symptoms may continue despite medication. In suitable patients in this situation, balloon treatment may be considered. This treatment is carried out with a tube with a camera at its tip (bronchoscope), passed through the mouth. Suitability is determined by a consultation and tests.

PRELIMINARY ASSESSMENT

Is it suitable for you?

Book an appointment and bring your breathing test and chest CT scan reports. We decide together at the consultation. If you are coming from outside Istanbul, an online preliminary consultation can be held first.

Please bring: your breathing test, your chest CT scan report and images (CD/USB), your list of medicines and, if you have one, your blood gas test result.

HAVE A QUESTION?

Frequently asked questions

The questions our patients and their relatives ask most often, with answers. We discuss questions about your own situation together at the consultation.

How many days does a COPD flare-up last?

It usually lasts 7–14 days. Full recovery may take a few weeks.

After an exacerbation, will I go back to how I was before?

Most patients do. In some patients, however, there is a permanent decline in lung function. This is why preventing flare-ups is very important.

Are antibiotics necessary?

They may be needed if your phlegm has turned yellow-green and increased in amount, or if the flare-up is severe. Your doctor makes the decision.

How many exacerbations a year are considered a lot?

Having two or more flare-ups a year is considered high risk. Having to stay in hospital because of a flare-up also means high risk. In this case, treatment is revised.

APPOINTMENT

Book an appointment for a preliminary assessment

To find out whether you are suitable, book a preliminary assessment appointment. Bring your breathing test, chest CT scan report and list of medicines with you.

info@yalcinkarakoca.com · Rüzgarlıbahçe Mah. Cumhuriyet Cad. Hasoğlu Plaza Kat:3, Kavacık / Beykoz, İstanbul

REFERENCES

International COPD guideline (GOLD 2026 report); Turkish Thoracic Society COPD Diagnosis and Treatment Consensus Report.

This page is for general information purposes. It does not replace a medical examination or diagnosis. Treatment decisions are made during an examination, on an individual basis. In an emergency, call 112.

Medical content review: Prof. Dr. Yalçın Karakoca, Pulmonologist · Last updated: 25 September 2026

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