Can Stress Cause COPD Flare-Ups or Exacerbation?

Can Stress Cause COPD Flare-Ups or Exacerbation?

Chronic obstructive pulmonary disease (COPD) is a progressive condition affecting the respiratory system, causing inflammation in the lungs and airways. It comprises health conditions, including chronic bronchitis and pulmonary emphysema, with similar prognoses and clinical characteristics.

Along with other health conditions, COPD is associated with increased chronic stress, anxiety, and depression levels. Having these conditions alone already impacts the overall quality of life. Therefore, co-existing with COPD worsens stress, anxiety, and depression. Unfortunately, this relationship is reciprocal, as these conditions worsen COPD symptoms.1

Despite the not promising relationship between stress and COPD, there are techniques to manage stress and COPD symptoms, thus, making both conditions more tolerable.

Can stress cause COPD Flare-ups?

Yes, stress can cause a COPD flare-up.2 Stress is an adaptive response of the body to a threat that prepares the body to fight the danger, to escape from it (fight-or-flight response).

This alert state is created by our bodies producing certain chemicals (e.g., hormones), which also increase the heart rate and blood pressure.

Overall, it increases the energy supply to the essential parts of the body for the stress response. Also, these chemicals affect our mood and emotions, making us more alert, awake, fearful, or angry.

Unfortunately, our mind does not distinguish if the source of threat is an attacking animal or a fear of possible COPD impact in the future. If the latter case persists for a long time, it eventually drains our energy, resulting in chronic stress, anxiety, or depression.

These put us at higher risk for heart diseases and impair our immune system and digestive systems. Also, these are well-known risk factors for worsening chronic health conditions, such as COPD.

COPD and doctor

What is a COPD Flare-Up?

Studies have demonstrated an increased link between stress, anxiety, depression, and COPD flare-ups. However, what is a COPD flare-up anyway?

To put it simply, a COPD flare-up, also known as COPD exacerbation, is a state of experiencing the typical COPD symptoms more intensely and for a more extended period than usual.

In most cases, the flare-up occurs after specific triggers, such as infection, stress, or anxiety; however, sometimes, the cause of a flare-up may be unknown.

A flare-up usually lasts up to two days; however, being a life-threatening condition, it can also lead to hospitalization.

Chronic Stress and COPD Flare-Up

There are enough reasons in life to get stressed. A short stress response even has beneficial effects on our body. However, chronic stress keeps the body in fight-or-flight mode for a long, eventually controlling the mood and emotions. One reason for chronic stress is a chronic health condition, such as COPD.

Imagine living with the effects of chronic stress, such as anxiety, sleep disturbances, shortness of breath, and mood swings, together with a long-term chronic progressive disabling condition, such as COPD.

The existence of the latter is often the main reason for chronic stress. Moreover, chronic stress is often the main cause of a COPD flare-up.

Fortunately, this should not be the case, and with some techniques, managing stress is more than possible during COPD.

stressed old woman

Other triggers of COPD Flare-Up

Nevertheless, stress and anxiety are not the only triggers for a COPD flare-up. Other triggers include:

  • respiratory infections;
  • smoking;
  • air pollutants;
  • poorly controlled asthma.

Signs and symptoms of COPD Flare-Up

People living with COPD know their usual symptoms well. This is a key factor for recognizing a COPD flare-up, as early recognition is an essential factor for early intervention. So, what are the signs and symptoms of COPD flare-up?

  • Fatigue;
  • Excess mucus, green, tan, or bloody;
  • Swollen ankles;
  • Sore throat;
  • Unusual sleepiness;
  • Difficulty breathing;
  • Fear or panic;
  • Chest pain;

What to Do When COPD Flare-ups Happen?

Your physician should provide instructions on what to do during a flare-up. For such situations, you should have nearby your inhaler and rescue medications. Below you can see how to distinguish the flare-up severity and some quick actions:3

Mild Flare-Up

  • Signs: shortness of breath more than usual; no coughing
  • Action: use your inhaler

Moderate Flare-Up

  • Signs: the inhaler is ineffective; coughing
  • Action: take your rescue medications; call your doctor

Severe Flare-Up

  • Signs: the rescue medicine is ineffective; fever; chest pain; intense shortness of breath
  • Actions: if you cannot reach your doctor, call 911

7 Tips to Prevent COPD Flare-Ups

If you have a COPD for a long time, you should be aware of the primary triggers of your flare-ups. The best way of preventing flare-ups is to avoid those triggers. If stress or anxiety is one of those triggers, another strategy would be making your body as ready as possible to encounter it without having a flare-up. For these purposes, you should:

  1. Identify stress factors: eg., people, job, thoughts;4
  2. Avoid stress factors: eg., avoid certain people;
  3. Practice relaxation exercises: eg., deep breathing, muscle relaxation exercises, letting go the negative thoughts;
  4. Practice healthy behaviors: eg., exercise, healthy diet, sleep, and getting up early;
  5. Talk it out: eg., talk about thoughts, emotions, and struggles;
  6. Manage COPD properly: eg., take medications as prescribed;
  7. If needed, get help: eg., see a specialist if dealing with stress alone does not help.

FAQs About COPD Flare-Ups

How long do COPD flare-ups usually last?

Usually, COPD flare-ups last up to two days.

Can Anxiety Make COPD Worse?

Yes, there is a strong association between anxiety and COPD flare-ups.

How Does COPD Affect You Emotionally?

COPD is associated with conditions affecting mood and emotions, including anxiety and depression.

Do Anxiety Medications Help with COPD?

If the cause of your COPD flare-ups is anxiety, then medications for anxiety can make the flare-ups less frequent.


COPD is associated with increased chronic stress, anxiety, and depression levels. Co-existing with COPD makes stress, anxiety, and depression even worse, which is reciprocal, as these conditions tend to worsen COPD symptoms.

These conditions are also one of the reasons for COPD flare-ups. There are other triggers of flare-ups as well. Awareness of those triggers and signs of flare-ups gives you a chance to prevent these exacerbations or get help as soon as possible.


  1. Yu T, Frei A, Ter Riet G, Puhan MA. Impact of Stressful Life Events on Patients with Chronic Obstructive Pulmonary Disease. Respiration. 2018;95(2):73-79. doi:10.1159/000481714
  2. Eisner MD, Blanc PD, Yelin EH, et al. The influence of anxiety on health outcomes in COPD. Thorax. 2010;65(3):229. doi:10.1136/THX.2009.126201
  3. COPD Flare-Ups: Symptoms, Causes, Treatments, Prevention. Accessed September 26, 2022.
  4. Heikkila K, Madsen IEH, Nyberg ST, et al. Job strain and COPD exacerbations: an individual-participant meta-analysis. Eur Respir J. 2014;44(1):247. doi:10.1183/09031936.00205113

About the Author

 Arno Hovhannisyan - author, emergency physician, medical researcher

After working as a paramedic and emergency physician, Arno has already shifted into healthcare research and medical writing for five years. While working as Healthcare Programs Coordinator, his research topics include community health and organizational healthcare. Simultaneously Arno is involved in academic writing and uses blog posts as a platform to transfer knowledge to the general audience.

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