The onset of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) signals a worsening prognosis. The exacerbation or flare-up can be recognized by its symptoms and signs, which warn you of some miserable and possibly last days ahead. Of course, the tests that diagnose the flare-up will clinch the final verdict.

Due to impaired gas exchange in the lungs of a COPD patient, there is more carbon dioxide in the blood and less amount of oxygen. This happens because of significant lung damage and some loss of lung function that this progressive respiratory disease causes.

As the disease progresses from stage one to stage four, the lung condition goes on worsening and there are acute flare-ups of the symptoms. These are called exacerbations.

The cardinal symptoms and signs of a COPD attack are a persistent cough with sputum, shortness of breath, initially on exertion, which progresses over time to a lesser degree of physical activity. In the later stages, breathlessness sets in even at rest.

The exacerbations start occurring from stage 2 onwards, but that is not the cardinal parameter. Some patients may start experiencing them in later stages. It depends on the health of the patient, the amount of lung damage, and most importantly, the history of exposure to any causes and risk factors that can trigger the exacerbation. Infection, bacterial or viral, is the most common cause.

The onset of an exacerbation in a COPD patient signals a poor prognosis and high mortality rate. COPD is the third largest cause of death worldwide and in the United States.

Acute COPD exacerbation symptoms and early warning signs

The symptoms of a COPD exacerbation are the same as the symptoms of the disease, but the intensity is greater. Depending on the exacerbation, whether mild, moderate, or severe, the intensity of the symptoms varies in its severity. The maximum number of exacerbations reported during a year is three, which are considered frequent.

COPD flare-ups often require hospitalization and the more severe ones may require admission to the intensive care unit. Prognosis in such cases is often poor. Readmissions are common after the initial admission due to persistent symptoms. The recovery period of a COPD exacerbation can take days or weeks.

Symptoms and signs of a COPD exacerbation include:

  • Shortness of breath is the most common symptom, which comes on at even a minimal exertion such as walking a few steps or may come on even at rest.
  • A persistent and severe cough with increasing amount and thickness of the sputum, which may be yellow, green, or even blood-tinged.
  • Fast and shallow breathing on exertion
  • On applying the stethoscope, the doctor can hear noisy breathing that could be wheezing due to mucus blocking the airways in the lungs or gurgling or rattling indicating the presence of fluid in the lungs can be heard.
  • Breathing requires effort and is irregular.
  • Anxiety
  • Insomnia meaning sleeplessness
  • Loss of appetite
  • A headache that is more in the morning due to the buildup of carbon dioxide and less oxygen in the blood.
  • Swelling of the feet and ankles due to COPD complications such as pulmonary hypertension and cor pulmonale

A COPD exacerbation is typically characterized by a rapid and persistent increase in the severity and frequency of symptoms, which mainly include

  • respiratory symptoms
  • feeling of weakness and being tired
  • sleep disturbance
  • dramatic reduction in activity

Symptoms that require emergency treatment

Sometimes, your flare-up symptoms could start to become severe. The symptoms that require emergency treatment are those caused by too much buildup of carbon dioxide in the blood. This can be a deadly and life-threatening situation, therefore act fast.

These symptoms include:

  • Altered mental status
  • Confusion
  • Dyspnea at rest
  • Difficulty to breathe even with medication
  • Chest pain
  • Blue lips or fingers