Reviewed by Barry J. Make, , Irina Petrache,

Insomnia from COPDThe earliest symptom of COPD is shortness of breath with activity. The earliest symptom of chronic bronchitis is a frequent cough with mucus production. Later symptoms of COPD include shortness of breath with activity and even at rest. A cough and phlegm may also be present.

Sometimes it is hard to know what to do when your symptoms change or worsen. You may have good days. You may have bad days. It is normal to have good and bad days. COPD flare-ups, called COPD exacerbations, are when your symptoms get worse. COPD flare-ups may also be called chest cold or bronchitis. Knowing when symptoms are changing is helpful, so that treatment and other interventions can begin quickly. Early treatment is most effective, and you may feel better more quickly. Accurate and timely assessment of your symptoms can help you and your health care provider decide if treatment should begin in the home, at your health care provider's office or in the emergency room.


Early Warning Signs

Early symptoms or warning signs of a COPD flare-up or exacerbation are unique to each person, and may be the same, similar or different with each episode in the same person. Usually, you will be the best person to know if you are having trouble breathing. However, some changes are more likely to be noticed by other persons. It is important to share this information sheet with your family and those close to you, since a change or increase in the symptoms you often have may be the only early warning sign. You may notice one or more of the following:
  • An increase in the amount of sputum produced
  • A change in sputum color to yellow or green or the presence of blood in the sputum
  • An increase in the severity of shortness of breath
  • A cough and/or wheezing
  • A general feeling of ill health
  • Trouble sleeping
  • Using more pillows or sleeping in a chair instead of a bed to avoid shortness of breath
  • Increased feeling of fatigue and lack of energy that is persistent
  • Forgetfulness, confusion, slurring of speech and sleepiness.


When to Call Your Health Care Provider

It is very important to work with your health care provider to determine the best treatment steps for signs and symptoms of an exacerbation. Here are some general guidelines for when to contact your health care provider, but your specific treatment plan should be determined by you and your health care provider.

  • Call immediately if:

    • Forgetfulness, confusion, slurring of speech or sleepiness occurs during an acute respiratory infection.

    • You are having a lot of trouble breathing, or you suddenly are unable to speak in complete sentences.

    • You cannot be easily awakened by others or you feel very weak.

    • You have blood in your sputum or develop a fever above 101 degrees or have shaking chills.

  • Call within 6-8 hours if:

    • Shortness of breath or wheezing does not stop or decrease with inhaled bronchodilator treatments one hour apart.

  • Call within 24 hours if:
    You notice one or more of the following severe respiratory symptoms:

    • Change in color, thickness, odor or amount of sputum persists.

    • You awaken short of breath more than once a night.

    • Fatigue lasts more than one day.


Things That Make Symptoms Worse

While there are many effective measures you can do at home to treat signs and symptoms, there are also actions that should be avoided:

  • Smoking
  • Taking codeine or any other cough suppressant
  • Using over-the-counter nasal sprays for more than three days
  • Increasing the liter flow of prescribed oxygen
  • Waiting any longer than 24 hours to contact your health care provider if symptoms continue.


National Jewish Health experts provided information on this topic for use on the U.S. News & World Report website.

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