Symptoms of Chronic Obstructive Pulmonary Disease (COPD)

Recognizing the symptoms of chronic obstructive pulmonary disease (COPD) and getting it diagnosed as soon as possible is one of the most important aspects of COPD management. Symptoms may 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. While COPD is often slowly progressive, it's common to have exacerbations during which the symptoms worsen for a time. Promptly recognizing the worsening of symptoms that may suggest a COPD exacerbation may also improve outcomes of the disease.

COPD symptoms
© Verywell, 2018

Frequent Symptoms

Noticeable COPD symptoms often don't show up until the disease is advanced and you've already incurred lung damage. People who are diagnosed and begin COPD treatment earlier in the course of the disease may have a better prognosis, so if any of these COPD symptoms sound familiar, contact your healthcare provider for further evaluation.

Shortness of Breath

Shortness of breath (dyspnea) is the hallmark symptom of COPD and usually 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. Other people describe the sensation 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 MMRC dyspnea scale is often used to help quantify these otherwise subjective symptoms so that you and your doctor can choose the best treatment options if you have COPD.

As a symptom, dyspnea is the most anxiety-producing, disabling feature of COPD. Thankfully, there are breathing exercises, as well as dietary tips, that can significantly help you cope.

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 small amounts of 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. While a chronic cough is common for people with COPD, there are many other, perhaps more serious causes of a persistent cough as well, and it's important to make sure they are ruled out.

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.

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.

Wheezing

Wheezing is often described as a whistling sound heard during inhalation and/or exhalation. 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.

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.

Severe 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 most likely less active, losing your appetite and weight loss are common problems in more advanced stages of the disease.

When not addressed, these symptoms can lead to malnutrition, a serious condition that can also be life-threatening. 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.

Good nutrition is important for anyone, but it's particularly essential when you have COPD. Many pulmonologists now recommend nutritional counseling for their patients with COPD, so if your doctor hasn't recommended it, you might want to ask for a referral.

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.

Swelling

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

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. It's helpful to know some of the ways to manage panic attacks in COPD, even if you've never had one.

Medications and other non-pharmacological treatments can help reduce the anxiety and depression associated with COPD, sometimes completely. If you suffer from either anxiety or depression, or both, or are noticing any other emotional effects of your disease, talk with your healthcare provider about your 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. The symptoms are similar to symptoms of COPD and it's 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.

When to See a Doctor

If you think you have COPD, you should make an appointment with your healthcare provider as soon as possible to discuss your symptoms. He or she can rule out or diagnose COPD and you can get started with treatment.

You should seek emergency treatment if you develop any of these symptoms:

  • The beds of your fingernails or your lips turn blue or gray, which indicates that the oxygen level in your blood is low (cyanosis).
  • You can't catch your breath or you're having a hard time talking.
  • You're not feeling mentally alert, especially if others notice.
  • Your heart is beating rapidly.
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