One goal of your COPD treatment is to limit how often you get a flare, or exacerbation. A flare is often on the horizon when symptoms like cough, shortness of breath, or sputum output get worse over time, usually over 7 to 14 days. A serious flare can put you in the hospital. And it’s not just smoking or air pollution that can bring one on. It helps to know other risk factors and how to stop them from making it harder to breathe.

There’s a snowball effect to flares: The more often you’ve had them, the more likely you are to have more of them in the future. (Three or more flares a year is considered frequent.) Care steps: Work with your doctor to pinpoint the underlying cause of each flare to better tailor treatment to your needs. Long-acting bronchodilators in particular can help reduce flares. 

Both bacterial and viral infections are common risk factors for a flare. Strep, the flu, COVID-19, RSV, and pneumonia are all culprits, but even a common cold can aggravate your airways. Care steps: Double down on efforts to avoid germs. Wash your hands often, and stay out of crowds during peak cold and flu season.  If you do get an infection, see your doctor to ID it and get the right treatment.

Didn’t get your flu shot this year? That’s a top risk factor for a flare. Ditto for not getting the updated pneumonia vaccine. In fact, studies have found that the flu vaccine can help prevent COPD complications and that both vaccines can help you lower the risk for a flare. That’s why they’re both recommended when you have COPD. Care steps: Schedule all overdue vaccines right away.

Being a couch potato isn’t good for anyone. With COPD, this makes a flare more likely. A low level of physical activity is linked to a faster rate of decline in lung function and more hospital visits for flares. Almost any level of physical activity helps prevent flares. Care steps: Join a pulmonary rehabilitation program to learn how to breathe better and exercise with COPD. Not doing so is a risk factor for flares. 

Oxygen therapy and prescribed meds, like bronchodilators and steroids, improve airflow and ease daily symptoms. Because blocked airflow sets you up for a flare, stick with your plan to make them less likely and less severe when they do happen. You’ll also have more stamina to exercise, which is another way to stay flare-free.  Care steps: Be consistent with treatment and review how to use your meds with your doctor if you’re unsure.

A high level of the type of white blood cell called an eosinophil is a marker, or sign, of airway inflammation and a key risk factor for flares. Other blood markers linked to flare risk are the protein fibrinogen and low levels of certain IgG antibodies. Care steps: Don’t skip needed blood tests -- results will help guide treatment. Check with your doctor on ways to lower inflammation.

There’s a link between the environment and flares, but air pollution isn’t the only problem. Research shows that hospital visits for serious flares are higher during cold weather. According to one study, 37.6% happen in winter, about 24% each in fall and spring, and just 14.6% in summer. Care steps: Avoid temperature extremes and windy conditions. If you must be out, wear a scarf around your face as a buffer between you and the elements.

Studies have found a connection between frequent COPD flares and low levels of vitamin D. That’s 25 nmol/L (10 ng/mL) or less compared to the normal level of 50 nmol/L (20 ng/mL). Care steps: If you don’t know your vitamin D level, ask your doctor for a blood test. Vitamin D supplements can get them back to normal and cut your number of flares.

Many people with COPD also have bronchiectasis, or damage to the tubes that bring air in and out of the lungs. This can make it hard to clear mucus, a breeding ground for bacteria. It could also explain why having bronchiectasis results in more serious COPD flares. Care steps: Work with a respiratory physiotherapist, who can teach you a technique called active cycle of breathing (ACBT) to help you better move mucus out of your lungs.

Chronic illnesses like diabetes, high cholesterol, high blood pressure, heart disease, and osteoporosis are all risk factors for serious flares -- those that need hospital care. Having asthma and COPD in particular poses a greater flare risk than either condition alone. Care steps: Make sure all your doctors coordinate your care so you can best manage all your health conditions.

You might be surprised to know that reflux is a risk for COPD flares, but the acids it creates irritate lung tissue. If you have COPD, you’re five times more likely to have GERD than people without the lung disease. And GERD makes a flare seven times more likely. Care steps: Report signs of reflux to your doctor, and adopt GERD-fighting habits like elevating the head of your bed and not eating before you go to sleep.

It’s the perfect storm: COPD causes a cascade of emotions, like stress, anxiety, and depression, and those emotions can put you at risk for a flare. Stress weakens your immune system and leaves you more open to infections. And when you’re depressed, you might be less likely to stick to your COPD treatment plan or exercise. Care steps: Get mental health help as soon as you can. Therapy and medication can boost your outlook and your desire to care for yourself.

While COPD symptoms slowly get worse in the days before a flare, other warning signs are clear red flags. These include changes in your oxygen saturation (SpO2), your pulse, and your respiration rate. Lower SpO2 is the best predictor. Care step: Take all three readings daily, log them in a journal, and call your doctor when you see telltale changes in the numbers. A simple pulse oximeter can measure your SpO2 and pulse.