Recognizing changes in signs and symptoms of your lung disease is an important part of managing your illness. People with chronic obstructive pulmonary disease due to Alpha-1 (Alpha-1 COPD) often have sudden “flare-ups” of symptoms (exacerbations). These may follow periods when they’re totally symptom-free.

Download Flare-ups – Signs, Symptoms, and More as a PDF.

We don’t understand flare-ups very well, and we don’t even have a clear, standard definition of what they are. But the one we use defines flare-ups as:

A sustained worsening of a patient’s condition beyond normal day-to-day variations that requires a change in regular treatment and medicine.

If you recognize worsening symptoms, you can seek treatment faster. It can also help you and your doctor decide how to treat your symptoms. Can you take care of them at home? Or do you need to see your doctor or go to the emergency room?

When does a bad day become a flare-up?

All patients with Alpha-1 COPD have an increase in cough, sputum production, and breathlessness once in a while. What turns a “bad day” into something worse?

Some factors that may cause a bad day include:

  • Weather
  • Allergies
  • Changes in air pressure
  • Higher altitude
  • Emotions
  • Using an empty inhaler

How to recognize flare-ups

Every person has different signs and symptoms before a flare-up. You’re usually the best person to know if you are having trouble breathing. But, some changes are more likely to be noticed by other people. Share information about signs and symptoms with friends, families, and coworkers.

Common warning signs of a flare-up include

  • More symptoms
  • Trouble breathing, even at rest
  • More wheezing and coughing
  • More thick, sticky mucus
  • Yellowish-green or bloody mucus
  • Chest tightness
  • Grumpiness or personality changes
  • Swelling in the hands or feet
  • Forgetfulness, confusion, slurring of speech, and sleepiness

Other possible signs of a flare-up include:

  • Fever
  • Rapid breathing and heart rate
  • Extreme tiredness and lack of energy
  • Needing to use more pillows or sleeping in a chair instead of a bed to avoid shortness of breath
  • Ashen or blue skin tone (cyanosis), especially in your fingertips or lips
  • More headaches, dizzy spells, and restlessness when you wake up

Understanding your respiratory rate

Respiratory rate means how many breaths you take per minute. It’s important to know your respiratory rate when you’re feeling good. This is your baseline. It’s hard to measure this for yourself, without unconsciously changing it. Ask someone else to help you count your breaths.

How to measure respiratory rate:

  1. Place one hand on your upper chest to feel it rise and fall.
    Each rise/fall cycle counts as one breath (respiration).
  2. Count your breaths for 30 seconds.
  3. Multiply the number of breaths by two.

How to measure heart rate (beats per minute)

Your heart rate may increase during a flare-up, so it’s good to know how to measure it.

  1. Find your carotid pulse
    Put your index and middle fingers to either side of your windpipe, underneath your chin.
    Press gently, without rubbing.
    You can also feel this pulse on the palm side of your wrist below your thumb.
  2. Count your pulse for six seconds
  3. Add a zero to the end of the count (equals beats/minute)
    For example, if you counted 7, your heart rate is  70.

What causes flare-ups?

Flare-ups are often triggered by respiratory infections, from a virus (cold or flu) or bacteria.

Doctors don’t prescribe antibiotics for most people with viral infections. However, people with Alpha-1 COPD often develop a secondary bacterial infection caused by damage to their lung tissue. So, whether your initial infection was caused by a virus or bacteria, your doctor may prescribe an antibiotic for you.

Other common causes of flare-ups include:

  • Indoor and outdoor air pollution
  • Heart failure (pulmonary edema)
  • Blood clots to the lung (pulmonary thromboemboli)
  • Other disorders

How to reduce and minimize flare-ups

You can’t totally prevent flare-ups. But you can have less severe ones, less often by following these guidelines:

  • Wash your hands often and properly.
  • Avoid close contact with people who have colds or the flu.
  • Keep your flu and pneumonia vaccinations up to date.
  • Keep your lungs working at their highest level by using more medicines to relax and open your airways (bronchodilators) and using them more frequently.
  • Use antibiotics and other medicines promptly if you have upper respiratory infections or sinus problems with colored mucus or drainage.
  • Monitor your lung function.
  • Use oral corticosteroids (OCS) promptly if your doctor prescribes them.

As you can see, there are many ways for you and your doctor to work together to reduce flare-ups.

For more in-depth information on this topic, please visit the Big Fat Reference Guide (BFRG). If you are enrolled in AlphaNet’s Subscriber Portal, you can access the BFRG here.

Download Flare-ups – Signs, Symptoms, and More as a PDF.