COPD at home: flare-ups, oxygen safety and the daily routine

COPD is lived one breath at a time, and most of the work happens at home. The moment that matters most is a flare-up, when symptoms are worse than usual and stay that way for 2 days or more.¹ That’s when the plan made with the provider gets used. This note covers spotting a flare-up, what to do at the first sign, using oxygen safely, the habits that help prevent the next one, and what home health adds.

The short answer

• A flare-up means symptoms worse than usual for 2 days or more: more trouble catching a breath, wheezing, more mucus or a change in its color.¹
• At the first sign, don’t panic. Use the quick-relief inhaler, pursed-lip breathing and oxygen if it’s prescribed, and follow the action plan.¹
• Call the provider if breathing gets harder, faster or shallower, or for a fever, dark mucus, chest pain, blue lips or fingertips, or trouble speaking in full sentences.¹
• Quit smoking, get a flu shot every year and the pneumococcal vaccine, and ask about pulmonary rehabilitation.²
• Keep oxygen at least 6 feet from flames and heat, and never let anyone smoke in the room.³

Knowing a flare-up

A flare-up is when symptoms get more intense than usual and last 2 days or more. The early signs are trouble catching a breath, wheezing, and coughing up more mucus or mucus that changes color.¹

It helps to write down what a normal day looks like: how far the person can walk, how much they cough, the usual color of the mucus. A flare-up is a change from that, and a written baseline makes the change easier to see and to describe on the phone.

What to do at the first sign

MedlinePlus advises:¹

• Don’t panic.
• Use the medicines prescribed for flare-ups, like a quick-relief inhaler.
• Use pursed-lip breathing to slow the breathing down and save energy.
• Use oxygen if it’s been prescribed.
• Follow the action plan made with the provider.

If symptoms don’t improve within 48 hours, or keep getting worse, contact the provider or go to the hospital.¹

When to call

Call the provider if breathing becomes harder, faster or shallower, or for a fever, dark mucus, blue lips or fingertips, chest pain, or trouble speaking in full sentences.¹ For severe trouble breathing, call 911.

Using oxygen safely

Oxygen and fire don’t mix, so the rules are strict. MedlinePlus lists them:³

• No one smokes in a room where oxygen is being used.
• Keep the oxygen at least 6 feet from wood stoves, fireplaces, candles and space heaters.
• Don’t use petroleum-based creams or lotions, like Vaseline, on the face or upper body unless the provider says it’s fine.
• Keep working smoke detectors and a working fire extinguisher in the home.

Don’t change the flow rate without checking with the doctor or respiratory therapist first. Medicare Part B covers home oxygen equipment when the provider finds the person isn’t getting enough oxygen and test results fall in Medicare’s required range. The equipment is rented from a supplier for 36 months, and after the Part B deductible the person pays 20% of the Medicare-approved amount.⁴

Preventing the next flare-up

• Quit smoking, and stay away from secondhand smoke.^1,2
• Avoid fumes, dust and smoke, and check the air quality at airnow.gov on bad days.²
• Get a flu shot every year and the pneumococcal vaccine. MedlinePlus also lists RSV and COVID-19 vaccines, so ask which are due.^1,2
• Wash hands often, and keep away from people who have colds.¹
• Take medicines as prescribed.²
• Ask the doctor about pulmonary rehabilitation, a program of exercise training and teaching about living with COPD.²

What home health adds

For people who qualify for home health, Medicare covers skilled nursing at home, including teaching the patient and caregiver and monitoring a serious illness or unstable health, and physical and occupational therapy when the conditions are met.⁵ For COPD, that usually means a nurse who checks breathing and oxygen levels, watches inhaler technique, goes over the medicines and the action plan, and calls the doctor early when something changes, and a therapist who helps the person build strength and save breath for the things that matter to them.

When COPD gets harder despite treatment, ask about palliative care. It focuses on comfort and quality of life, and it can be given alongside treatment.