NICE defines an exacerbation as a “sustained worsening of the patient’s symptoms from their usual stable state, which is beyond normal day-to-day variations and is acute in onset”. Commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour. The change in these symptoms often necessitates a change in medication and the use of a rescue pack. Points to reinforce include:  

• Recognising the start of an exacerbation (e.g. whether there has been a change in the volume, purulence or colour of the phlegm produced normally and whether they are experiencing a change in breathlessness or wheeze) 
• Understanding the risks and benefits of prescribed treatments
• Alarm symptoms – things to be alert for that are not typically part of an exacerbation or signs that might mean something different is going on 
• Contacting their healthcare professional if a patient has started treatment to alert them that they have become unwell.