Symptoms of Chronic Obstructive Pulmonary Disease (COPD)

A chronic cough, wheezing, and shortness of breath are classic symptoms of chronic obstructive pulmonary disease (COPD), though there are others. As the disease makes airways constrict, phlegm accumulates, breathing requires a lot of effort, and infections can occur. The nature of COPD is one of repeated bouts of exacerbation, and your symptoms may vary with each episode.

The disease is a progressive one. Recognizing the symptoms of COPD can help you get an early diagnosis, which is likely to improve your outcome. Symptoms of an exacerbation are more sudden, and if you have COPD, you need to be able to identify signs of worsening disease or a COPD exacerbation so you can safely manage your condition.

COPD symptoms
© Verywell, 2018

Frequent Symptoms

Noticeable COPD symptoms may not show up until the disease is advanced and you've already incurred lung damage. 

Common symptoms in early COPD, should they occur, include shortness of breath, wheezing, cough, fatigue, phlegm production, and chronic respiratory infections, which can range from mild to very severe depending on the stage of the disease.

Shortness of Breath

Shortness of breath (dyspnea), the hallmark symptom of COPD, can often be the first symptom to appear. Shortness of breath due to medical conditions can be described in several ways, but many people with COPD describe dyspnea as feeling like gasping or labored breathing. The sensation is also often described as "air hunger."

Initially, you may only experience dyspnea when you exert yourself. However, as the disease progresses, dyspnea may occur even while you’re resting. A tool known as the Modified Medical Research Council (mMRC) Dyspnea Scale is often used to help quantify these otherwise subjective symptoms.

As a symptom, dyspnea is the most anxiety-producing, disabling feature of COPD.

Exercise Intolerance

You may be unable to tolerate exercise or moderately strenuous activities like climbing the stairs in your house. With advanced COPD, you might not even be able to walk from one room to another.

Healthy people generally need to breathe faster and deeper while exercising to get enough oxygen and energy. With COPD, air actually becomes trapped inside the lungs, a condition described as hyperinflation of the lungs. The disease prevents you from taking deep breaths when you exercise, so you can't absorb enough oxygen to get the energy needed for physical exertion. You will notice that you have to sit down and rest.

Sputum (Phlegm) Production

Sputum, also called mucus or phlegm, is a protective substance produced by your lungs to aid in the trapping and removal of foreign particles. Sputum is secreted by cells that line the airways (the bronchi and bronchioles) and is expelled by coughing or clearing your throat.

People with COPD often produce tenacious sputum when they cough. Causes of increased mucus include both increased production by the airway cells (goblet cells) and a decreased ability to remove mucus due to dysfunction of the cilia, the tiny hair-like structures lining the airways.

A large amount of thick sputum is often associated with a bacterial lung infection, which can exacerbate COPD symptoms. The color and consistency of sputum may change when a bacterial infection is present.

Chronic Cough

chronic cough in COPD is one that is long-term and doesn't seem to go away. Medically, it's defined as a cough that lasts for a period of at least eight weeks.

A cough with COPD can be dry (non-productive) or produce mucus. With some types of COPD, such as chronic bronchitis, the cough occurs daily and is associated with mucus production. Initially, the cough may be intermittent, but as the disease progresses, it may be present every day.

A chronic cough is often the initial symptom of the disease, yet it's one that gets overlooked because many people attribute it to smoking ("smoker's cough"), allergies, or other environmental irritants.

Wheezing

Wheezing is often described as a whistling sound heard during inhalation, exhalation, or both. It’s caused by a narrowing or blockage of your airways. Wheezing may or may not be accompanied by abnormal sounds heard with a stethoscope.

Chest Tightness

Tightness in the chest may give you a feeling of pressure within the chest walls that makes automatic breathing difficult. Chest tightness may be present when there is an infection in your lungs and it may make deep breathing painful (pleuritic chest pain), causing respiration to be short and shallow.

Airflow Limitation and Your Symptoms

Long-term exposure to airway irritants causes the airways to become swollen and inflamed, obstructing airflow to and from the lungs. This process, referred to as airflow limitation, gets progressively worse over time, especially if such exposure continues. Airflow limitation directly correlates with the decline in lung function (and related symptoms) seen in COPD.

Chronic Respiratory Infections

Another common symptom of COPD is often having colds, the flu, and/or pneumonia. COPD makes you more susceptible to these illnesses because you're unable to clear out your lungs sufficiently.

Fatigue

Fatigue-related to COPD is different than ordinary tiredness. This poorly understood and often underreported symptom of COPD is something that doesn't respond well to a cup of coffee or even a good night's sleep.

Overall, fatigue is three times more common in people with lung disease than in those without it. While dyspnea is the most worrisome symptom among those with COPD, fatigue can be one of the most bothersome. But more than that, fatigue associated with COPD increases the risk of hospitalizations.

Advanced-Case Symptoms

There are symptoms that may occur more often when your COPD is severe or you're in the later stages of the disease.

Weight Loss and Loss of Appetite

While weight gain is more of a problem in the early stages of COPD, since you're likely to be less active, losing your appetite and weight loss are common problems in more advanced stages of the disease.

Good nutrition is important for everyone, but it's particularly essential when you have COPD. When not addressed, these symptoms can lead to malnutrition, a serious condition that can also be life-threatening.

Many pulmonologists recommend nutritional counseling for patients with COPD.

Both appetite loss and unintentional weight loss are symptoms that warrant further investigation, as they may also indicate that other diseases are present, such as lung cancer or pulmonary tuberculosis.

Muscle Atrophy

Cachexia is a condition that includes both weight loss and muscle wasting and is a significant cause of death in people with many chronic diseases, including COPD.

Swelling

You may notice swelling in your legs, ankles, and feet as the disease progresses or if your COPD is severe.

In Women

Overall, women seem to be more susceptible to the side effects of smoking than men. In COPD, women are more likely to experience:

  • More severe shortness of breath
  • More anxiety and depression
  • Lower quality of life
  • Increased airway hyperresponsiveness
  • Worse exercise performance
  • More frequent exacerbations than men
  • Greater risk of malnutrition
  • Greater reduction in lung function at comparable levels of smoking than men

The effects of COPD are also more detrimental in women than they are in men. Once considered a "man’s disease," since 2000, more women have died from COPD each year than men.

Complications

Many complications can occur as a result of COPD. Being aware of them can help you stay on top of your symptoms and get treatment as soon as possible if they occur.

Recurring Respiratory Infections

While chronic respiratory infections can tip you and your doctor off to COPD, they can also further damage your lungs.

It's important to get your flu shot every year and to talk with your doctor about getting the pneumococcal vaccine to help decrease the number of infections you pick up.

Anxiety and Depression

The emotional effects of COPD, especially anxiety and depression, are often overlooked. These symptoms are important not only due to their effect on your quality of life, but because they increase the risk of COPD exacerbation and a poorer health status overall.

Panic attacks are also very common among people with COPD and can lead to a vicious cycle when combined with shortness of breath.

Medications and other non-pharmacological treatments can help manage these concerns. Talk with your healthcare provider about treatment options.

Heart Disease

Having COPD may increase your risk of heart disease and heart attack. Smoking can be a contributing factor to this, so quitting may help.

Pulmonary Hypertension

High blood pressure in the arteries in your lungs, called pulmonary hypertension, is a common complication of COPD, especially in the advanced stages of the disease.

Symptoms of hypertension can be similar to COPD. The condition is usually diagnosed via imaging and/or lab tests.

Lung Cancer

COPD is a strong independent risk factor for lung cancer, meaning that it raises your risk even if you have never smoked. And, of course, if you do light up, quitting can help lower the added risk of your habit.

Respiratory Failure

Respiratory failure can be a complication of COPD. It occurs when your lungs fail to do their job passing oxygen into your bloodstream and removing carbon dioxide.

The first symptom of respiratory failure you might notice is shortness of breath—you’ll feel as if you just can’t take a deep breath or get enough air in your lungs. You may also start breathing rapidly.

When your lungs don't efficiently transfer oxygen and carbon dioxide, cells in your body start to suffer from a lack of oxygen (hypoxemia), too much carbon dioxide (hypercapnia), or both.

This is why you can experience systemic symptoms of respiratory failure, such as:

  • Feeling tired or fatigued
  • Lethargy (you won’t have any energy)
  • Sleepiness
  • A bluish tinge to your skin
  • Confusion

As the disease progresses, efficiency of gas exchange in the lungs generally declines, leading to worsening symptoms, disability, and severe illness.

When to See a Doctor/Go To the Hospital

Talk to your doctor if you experience any of the above symptoms or complications, especially if they are chronic and/or you have risk factors for COPD. Symptoms of COPD may come and go and can overlap with those of other illness. In fact, you might think that you have a lingering infection or a "cold" that you can't shake—but you need medical attention to know for sure and to begin any appropriate treatment.

If you already have COPD, know that your disease can progress and that exacerbations are the rule rather than the exception with this disease.

COPD Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

Signs of Worsening COPD

If you have already been diagnosed with COPD, you need to be closely monitored by your doctor for a worsening of your disease. Keep up with suggested appointments so you can be evaluated on an ongoing basis and your medication can be adjusted, if needed.

Call your doctor if you develop:

  • A worsening cough, either in frequency or severity
  • A change in the amount or color of your sputum
  • Blood when you cough
  • Increased shortness of breath
  • Shortness of breath on awakening
  • Need to elevate your head more than usual to sleep
  • Increased wheezing
  • Frequent headaches
  • A fever over 101 degrees F
  • Symptoms of the flu such as a fever, body aches, and sore throat
  • Increased swelling in your legs, especially if it is not relieved with elevation
  • Weight gain of more than two pounds in a day or more than five pounds in a week
  • Unintended weight loss
  • Anxiety and/or restlessness
  • Inability to walk as far as you ordinarily can, or take as many stairs as you ordinarily could
  • Increasing fatigue or weakness
  • Increased need for breathing treatments

When to Call 911

Even if your COPD symptoms are well managed with medication, there is a risk of sudden respiratory distress or even death from the disease. This is a medical emergency.

If you or your loved one have any of the following symptoms, seek immediate medical attention:

  • Severe or sudden shortness of breath
  • Difficulty speaking due to shortness of breath
  • Confusion or forgetfulness
  • Extreme fatigue and decreased alertness
  • Difficulty waking from sleep
  • Chest pain
  • Rapid heart rate
  • Blue fingers or lips
  • Coughing up more than a teaspoon of blood

Create an Emergency Action Plan

It can be helpful to plan ahead for emergencies with COPD. Make sure you know how to call for emergency help. Be ready with your medical history and medication list so emergency healthcare providers will be aware of this when taking care of you.

Take time to talk with family members and loved ones who are near you, so they are also aware of symptoms that should prompt them to call 911 if you can't do it yourself.

A Word From Verywell

COPD symptoms can be a roller coaster ride of ups and downs. Preparing for those downward slopes while you're riding smooth may not only decrease the impact of exacerbations but can also preserve your ability to pursue the activities you enjoy in your daily life. 

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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