context: As chronic obstructive pulmonary disease ( COPD) gets worse, it limits your airflow more and more. By stage II, your symptoms are usually no longer something you can just shrug off. They start to affect your daily life. Since it's sometimes easy to miss the early signs of COPD, this is the stage where a lot of people go to the doctor to find out what's going on -- and may first learn they actually have the disease. Anything you had in the first stage often gets worse in stage II. Not everyone gets the same symptoms, but you may have: Constant coughing, along with mucus, that's often worse in the morning Shortness of breath that makes even household chores a challenge Tiredness Trouble sleeping Wheezing when you exercise or during a flare-up It can start to affect your mental health, too. You may get forgetful, confused, or have slurred speech. You may also start to have flare-ups, called exacerbations. This is when your symptoms get worse for several days at a time. They can be very serious. Keep an eye out for: Feeling confused Being more breathless than usual Change in color of mucus, which may be the first sign of a flare-up Change in amount of mucus, either more or less More coughing More tiredness New sleep problems Tell your doctor if you have any of these. Get medical help right away if you feel confused or have trouble breathing. As with stage I, you'll talk to your doctor about your health history and get a physical exam. You'll also take a simple breathing test, which tells you if you have COPD. One of the results from it, known as "forced expiratory volume in one second" ( FEV1), tells you the stage you're in. You have stage II if FEV1 is from 50% to 80%. From there, you may get blood tests, exercise tests, imaging, and more. They'll reveal important details about how COPD is affecting your body and how your lungs are working. That can help you and your doctor figure out the best treatment. Managing COPD can be complex, so you'll need to work closely with your doctor. The goal is to relieve your symptoms, keep your lungs working as well as possible, and prevent flare-ups. For stage II, the main treatments are: Medicine. Typically, you get drugs called bronchodilators, which make breathing easier. You often get two types: Short-acting ones last 4-6 hours. You take them when you need relief from symptoms. Long-acting ones last 12 or more hours. You take them every day to help keep things in check. You may get more than one of these. Pulmonary rehab. This is a program aimed at helping you keep up your quality of life. You may work with doctors, nurses, physical therapists, and others to create a plan tailored to your needs. Your plan might include things like: Counseling to help with the challenges of having a long-term health condition An exercise routine that's safe for you Tips on how to eat a healthy diet Training on ways to best manage COPD It's important to take an active role in your treatment. When you keep on top of your meds, appointments, and other parts of your program, you lower your odds of having a flare-up or needing to go to the hospital. Managing flare-ups. Like the disease itself, flare-ups may range from mild to severe. Your doctor will help you come up with a plan for how to handle them. For a mild flare-up, you may need to take bigger doses of your regular meds. For more serious ones, you may need: More medicine, such as steroids and antibiotics Oxygen, since it usually drops during a flare-up Treatment in the hospital It's best to deal with flare-ups in the early going and not to wait until they get worse. If you're not sure what to do, call your doctor as soon as possible. To help prevent them, quit smoking, get your flu and pneumonia shots, and stick to your pulmonary rehab plan. Flare-ups can land you in the hospital, and they can be life-threatening. They can cause your oxygen levels to fall sharply, make it very hard to catch your breath, and throw off your heart rhythm. COPD also raises your odds of having heart disease, lung cancer, and high blood pressure in your lungs. Check with your doctor to see how you can limit your risks for these other conditions. Make sure you tend to your overall well-being and keep an eye on your mood, since people with COPD can sometimes get depressed. If you find that you're often sad or feel helpless or hopeless, talk to your doctor.