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Risk and Complications

Risk Factors

  • Cigarette smoking is the most common risk factor, causing 80-90% of COPD cases.
  • Other types of tobacco (pipe, cigar, water pipe), second-hand smoke, and cannabis are also risk factors
  • Workplace exposure to dusts, chemical agents and fumes account for approximately 10-15% of all COPD
    • Examples of occupations with an increased risk include farmers, welders, painters, railroad workers, miners, carpenters, metal workers, construction workers, and cement factory workers
  • Air pollution is linked to a decrease in lung function
  • Severe lung infections during childhood
  • Genetics/family history
    • e.g., Alpha-1 Antitrypsin Deficiency is a rare genetic disorder that increases the chance of developing emphysema
    • If one sibling has COPD, another sibling who smokes has a higher risk of developing COPD
  • Asthma/bronchial hyperreactivity:
    • Asthma may be a risk factor for the development of COPD
    • Bronchial hyperreactivity (overly sensitive airways) can exist without a diagnosis of asthma and has been shown to increase the risk of COPD
  • Lower socioeconomic status is a risk factor for COPD
  • Cooking and heating with biomass (e.g., wood, coal, crop waste) in homes with inadequate ventilation (this is more of a risk in developing countries but is also a risk in some parts of Canada due to wood burning)

Quitting smoking is the single most effective step to reduce the risk of developing COPD.

COPD can also be caused by more than one risk factor.

COPD Flare-ups

A COPD flare-up or lung attack (exacerbation) happens when symptoms get worse or when new symptoms develop. COPD flare-ups are caused by:

  • Infections (most common cause)
  • Air pollution
  • Unknown reasons

It is important to prevent COPD flare-ups since they can cause a decrease in your lung function over time.

How to prevent COPD flare-ups

  • Quit smoking: it’s the best way to slow down disease progression
  • Take good care of yourself. Eat healthy foods, exercise regularly and get enough sleep. Staying healthy will help your body fight infections.
  • Wash your hands properly and often to reduce your chance of picking up germs and getting sick.
  • Avoid touching your eyes, nose or mouth when in public. Many people catch colds, flu, and other contagious respiratory (lung) infections by touching their face. They don’t realize that there are germs on their hands that can make them sick.
  • Stay away from people who are sick.
  • Take all of the medications prescribed by your health-care provider
  • Ask your health-care provider for a personalized written COPD action plan. A COPD action plan gives written instructions from your health-care provider on what to do when your symptoms flare up. Your COPD action plan will tell you what extra medication to take, when to call your health-care provider, and when to go to the emergency department. Here is a blank COPD action plan (PDF) that you can fill out with your health-care provider.
  • Get your flu vaccine every year. Ask your health-care provider if you need a pneumonia vaccine.
  • Avoid the triggers that can make your COPD worse, like air pollution, tobacco smoke, strong fumes, perfume and breathing very cold or very humid air.

Flu and Pneumonia Vaccines

Vaccines can help protect you against some strains of flu and pneumonia. Flu and pneumonia vaccines can lower your chances of getting a flare-up and needing hospital care.

You will need to get a flu vaccine every year, usually in the fall. Find a flu vaccine clinic in Ontario: www.ontario.ca/flu.  Some people with COPD may need to get another pneumonia vaccine after 5 – 10 years.


Warning signs and symptoms of a COPD flare-up

  • An unusual increase in shortness of breath
  • Increased cough
  • Change in mucus (phlegm) colour – more yellow, green or brown than usual
  • An increase in the amount, thickness or stickiness of your mucus (phlegm)
  • Fever
  • Symptoms of a cold, such as a headache, runny nose, or sore throat
  • Swollen ankles
  • Feeling tired and generally unwell

What to do if you have these symptoms

If you notice any of these symptoms, follow the advice in your written COPD action plan. If you don’t know what to do or you don’t have a COPD action plan and if your symptoms are getting worse, call your health-care provider. If you can’t reach them, go to the hospital emergency department.

Warning signs of a severe COPD flare-up –
Call 911 if you have these signs

  • Chest pain
  • Blue lips or fingers
  • Confusion, can’t think clearly, or very agitated (upset)
  • Drowsy
  • Very short of breath

Treatment for a COPD flare-up or lung attack (exacerbation)

It’s very important that you treat your COPD flare-up as early as possible. If you treat a flare-up early, you are less likely to need hospital care and it be less likely to affect your lung function. To treat a flare-up, follow the advice in the above sections and the instructions in your written COPD action plan.