People with chronic obstructive pulmonary disease (COPD) may occasionally have symptom exacerbations, or flare-ups. Treatments options for exacerbations include bronchodilators, corticosteroids, antibiotics, oxygen therapy, and ventilation.

COPD is the name given to a group of long-term lung diseases. The condition tends to get worse over time and symptoms can include:

  • wheezing
  • shortness of breath
  • coughing
  • excess mucus production
  • chest tightness
  • fatigue

People with COPD may occasionally notice that their symptoms suddenly get worse, or that new symptoms develop. Doctors refer to these periods as exacerbations, or flare-ups.

In some people, certain things, such as an infection, a change in the weather, or exposure to irritants or allergens, can trigger an exacerbation.

In this article, learn about some of the options for treating a COPD exacerbation. We also discuss the importance of treating exacerbations, when hospitalization may be necessary, and some tips for preventing exacerbations.

Treatment options for exacerbations

Generally, the sooner a person begins treatment for a COPD exacerbation, the better. Several treatment options are available, including:


Man holding a bronchodilator<!--mce:protected %0A-->for copd exacerbation treatment
A bronchodilator can open the lungs to ease the symptoms of a COPD exacerbation.

Bronchodilators are medications that relax the muscles of the airways, which helps them open up. One of the most common bronchodilators that doctors prescribe for people with COPD is albuterol.

A COPD exacerbation may result in increased chest tightness, wheezing, or shortness of breath. Taking medication to open the lungs, such as a bronchodilator, can help ease these symptoms.

Bronchodilators typically come in the form of an inhaler device or a liquid. To take the liquid form, a person must use a machine called a nebulizer to turn the liquid into an aerosol or mist, which a person can then inhale into the lungs.

Side effects of using a bronchodilator may include a faster heart rate, a headache, and shakiness.


Increased inflammation of the lungs and airways can trigger a COPD exacerbation. Corticosteroids can help reduce this inflammation and relieve symptoms.

Corticosteroids come in many forms, including tablets, inhaler devices, and injections. Corticosteroids that doctors commonly prescribe for the treatment of COPD exacerbations include prednisone and budesonide.

Corticosteroids can cause systemic side effects, especially when a person takes them intravenously or orally. Systemic side effects can affect the whole body.

Possible side effects include increased blood sugar, nervousness, and headache. Nebulized corticosteroids may cause hoarseness, dry mouth, or oral yeast infections.

The best way to administer corticosteroids to treat a COPD exacerbation depends on the type and severity of symptoms. However, the results of a 2014 study suggest that nebulized corticosteroids may be as effective as intravenous corticosteroids but with fewer systemic side effects.


People with COPD are more likely to develop a lung infection than those without the lung disease. These infections can lead to an exacerbation, and people with COPD may be more likely to experience complications from lung infections.

If a doctor suspects that a person with COPD has a bacterial infection, they may prescribe them a course of antibiotics.

The results of a 2013 study that involved 53,900 participants suggest that adding antibiotics to a treatment plan that also included corticosteroids may briefly improve symptoms for people in the hospital with a COPD exacerbation.

Oxygen therapy

A person’s oxygen levels may decrease during a COPD exacerbation. Oxygen therapy can help improve oxygen levels in the blood and ease the related symptoms, such as shortness of breath.

During oxygen therapy, a person will inhale oxygen from a machine through a mask or via nasal tubes. People can use an oxygen therapy machine at home.

Noninvasive ventilation

A woman using a Noninvasive ventilation machine <br>Image credit: James Heilman, 2014 </br>
People with severe COPD exacerbation may need treatment with noninvasive ventilation.
Image credit: James Heilman, 2014

Noninvasive ventilation (NIV) is a type of respiratory support that can improve oxygen levels, inflate the lungs, and make breathing easier. NIV involves a machine that delivers pressure and oxygen to the lungs through a mask.

Doctors will typically provide NIV to people in the hospital with a severe COPD exacerbation.

A 2017 study reviewed 17 clinical trials that involved 1,264 people who were in the hospital with COPD. The researchers found that participants who underwent NIV had a 46 percent lower risk of death than those who did not undergo NIV.

NIV treatment also reduced the length of hospital stays and lowered the risk of experiencing COPD-related complications.

Intubation and ventilation

During intubation, a specialist will insert a breathing tube into a person’s windpipe to allow for mechanical ventilation, or assisted breathing. The specialist will then connect the breathing tube to a ventilator, which is also known as a breathing machine or a respirator.

Doctors may use a ventilator if a person is unable to breathe on their own, or their breathing is ineffective at removing carbon dioxide or oxygenating the lungs.

The machine can deliver a set number of breaths per minute, a volume of air, and pressure to the lungs. It also delivers oxygen.

Importance of treating a COPD exacerbation

It is critical for a person to begin treatment for a flare-up of COPD symptoms as soon as possible. Exacerbations can trigger a decrease in oxygen levels in the blood or issues removing carbon dioxide from the body, which can result in respiratory failure.

Recognizing the signs of a COPD exacerbation quickly and seeking appropriate treatment may prevent a flare-up from becoming life-threatening.

When is hospitalization necessary?

A person may treat a COPD exacerbation at home using oxygen and medications. However, there may be other cases in which hospitalization is needed.

At the hospital, medical professionals can continuously monitor a person, as well as administer specialized treatment.

Signs that a person with COPD may need to go to the hospital include:

  • getting no relief from the use of inhalers
  • experiencing confusion or a decreased level of consciousness
  • noticing swelling in the legs or feet
  • feeling chest pain
  • having fingers, toes, or lips that are bluish or gray

Preventing a COPD exacerbation

woman breaking cigarette in half
Quitting smoking can help prevent COPD exacerbations.

The following tips may help prevent or reduce COPD exacerbations:

  • stopping smoking and avoiding secondhand smoke
  • getting an annual flu shot
  • avoiding COPD triggers, such as air pollution, pollen, dust, and fumes
  • taking all medications as the doctor directs
  • getting plenty of sleep to keep the immune system strong
  • washing hands often to prevent infection


COPD exacerbations are events during which a person’s symptoms suddenly become worse or new symptoms develop. Certain strategies, such as avoiding triggers, can help reduce the chance of experiencing a COPD exacerbation. However, it is not always possible to prevent them.

Treatment depends on the type and severity of the exacerbation and can include bronchodilators, corticosteroids, antibiotics, oxygen therapy, and ventilation. Sometimes, a person may need more than one form of treatment.

Prompt recognition and treatment of a COPD exacerbation can reduce the need for hospitalization and may lower the risk of complications. A doctor can provide a treatment and action plan for dealing with exacerbations.