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- Severe breathlessness, or you are unable to speak in sentences;
- Blue lips or fingertips;
- Drowsiness or confusion;
- Chest pain;
- Coughing up a lot of blood.
Call 000 or go to your nearest emergency department. Do not wait for the rescue pack to work. Everything below is for recognising a flare-up early — it does not replace acting on these signs now.
A flare-up (also called an exacerbation) is when your usual symptoms get worse and stay worse — more breathless, more cough, or more, thicker or darker sputum than normal for you. Spotting it early and acting quickly can keep you out of hospital. This page helps you recognise the warning signs and know what to do at each stage.
What a flare-up is
A flare-up is a sustained worsening of your respiratory symptoms beyond your normal day-to-day variation, usually needing a change in treatment.1 Most are triggered by a viral or bacterial chest infection, but air pollution, smoke, allergens and cold air can all set one off. The earlier you recognise it, the more you can do at home.
Know your "normal"
The key to catching a flare-up is knowing your usual baseline — how breathless you normally are, how much you usually cough, and the usual colour and amount of your sputum. A written record or your action plan makes changes easier to spot.
Warning signs
- Breathing — more breathless than usual, with everyday tasks, or at rest.
- Cough — a new or worsening cough, or coughing more often.
- Sputum — more of it, thicker, stickier, or changing colour (see the sputum guide and colour chart).
- Wheeze or chest tightness that is new or worse.
- Feeling generally unwell — tired, feverish, reduced appetite, needing your reliever more often.
Sputum colour chart
Use this as a general guide only — read colour alongside how much there is, how thick it is, and how it compares with your usual. A sustained change is more meaningful than a one-off.2 Your personalised plan always takes priority.
After a flare-up
Keep going with your airway clearance and gentle activity as you recover — don't stop moving altogether. If you used a rescue pack, tell your GP within 48 hours so it can be reviewed and replaced, and book a review after any flare-up that needed antibiotics or steroid tablets. Current COPD guidance treats a single moderate flare-up as reason enough to review and step up treatment, rather than waiting for two or more in a year.1 These are guidelines, not rules — a clinician should still apply clinical judgement to the individual patient.
Act with your traffic-light plan
Match what you notice to your personalised plan. As a general guide:
Symptoms at your usual level. Keep taking your regular inhalers, do your daily airway clearance, stay active, and keep your rescue pack in date.
Symptoms worse than usual for more than a day. Step up your airway clearance, start your rescue pack as your plan directs, and tell your GP or clinic within 48 hours.3 Learn more in When to start rescue packs.
Severe breathlessness, unable to speak in sentences, blue lips or fingertips, drowsiness or confusion, chest pain, or coughing up a lot of blood — call 000 or go to your nearest emergency department. Do not wait for the rescue pack to work.
References & evidence base
- Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of COPD: 2026 report. GOLD; 2026. Available at: goldcopd.org
- Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax 2019;74(Suppl 1):1–69.
- Lung Foundation Australia. COPD action plan. Brisbane: Lung Foundation Australia, 2024.
References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use.
Everything starts with an assessment — your symptoms, breathing, exercise tolerance and daily function measured properly, so what follows is built on your lungs rather than an average.
Corrections: If something on this page is wrong, out of date or unclear, we want to know. Email reception@inspireclinic.au with the page name and what you believe is incorrect. Substantive corrections are made promptly, and the guide’s version and last-updated date are changed to reflect it.