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 airways constrict, phlegm may accumulate, breathing may become more challenged, 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. Knowing the symptoms of COPD can not only help you get an early diagnosis, which is likely to improve outcomes, but it can help you promptly recognize the a COPD exacerbation and help you better 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. 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 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.

Air Trapping

As COPD progresses, airway obstruction causes more and more air to become trapped inside the lungs during exhalation. Like an over-inflated balloon, air trapping causes hyperinflation of the lungs, which in turn limits the amount of air that a person is able to inhale.

Eventually, as air trapping continues, the volume of air left in the lungs after a normal exhalation (functional residual capacity) increases, especially during exercise. This is the main reason that people with COPD become short of breath during exercise and have a reduced ability to tolerate strenuous activity.

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.

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 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 start breathing rapidly.

Other possible symptoms include:

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

If you have chronic respiratory failure as a result of COPD or another chronic condition, you can receive treatment for it at home or in a long-term care facility.

Abnormalities in Gas Exchange: A Closer Look

Your organs, muscles, and other tissues need oxygen. Your lungs are responsible for bringing oxygen into your body, where it is picked up by your red blood cells and transported where it is needed. Meanwhile, carbon dioxide — the waste gas produced by your cells as they use the oxygen — moves from your bloodstream and back into your lungs, where you exhale it. This entire process is called gas exchange.

In respiratory failure, the gas exchange doesn’t work the way it’s supposed to work, and the cells in your body start to suffer from a lack of oxygen (hypoxemia), too much carbon dioxide (hypercapnia), or both. Too much carbon dioxide can disrupt the acid-base balance in the body, which in itself can lead to respiratory failure. As the disease progresses, the impairment of gas exchange generally worsens, leading to worsening symptoms, disability, and severe illness.

When to See a Doctor/Go To the Hospital

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

When you have COPD, it’s extremely important that you are closely monitored by your doctor for a worsening of your COPD symptoms.

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

If you have symptoms that could be a life-threatening emergency, don’t wait for your doctor to return your call. Call 911 first.

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

Call 911 If You Have These Symptoms

People with COPD still die today because they don’t make it to the emergency room on time. If you have any of these symptoms, call 911.

  • Severe or sudden shortness of breath
  • Confusion or forgetfulness
  • Difficulty awakening
  • Chest pain
  • Blue fingers or lips
  • Coughing up more than a teaspoon of blood
  • Extreme fatigue, weakness, or confusion
  • A need to use your breakthrough medications more often than recommended

Call or See Your Doctor If You Have These Symptoms

If you believe your symptoms are an emergency, call 911 and ask questions later. Otherwise, be aware of these symptoms which should prompt you to call your doctor right away.

  • A worsening cough, either in frequency or depth
  • A change in the amount of your sputum or the color of your sputum
  • Coughing up blood – any blood at all. Coughing up more than a teaspoon of blood is an emergency and coughing up just a third of a cup of blood is considered massive hemoptysis and has a mortality rate (death rate) of 30 percent
  • Increased shortness of breath, a change in your perception of shortness of breath, or shortness of breath on awakening
  • Need to elevate your head more than usual to sleep or the need for more pillows
  • Increased wheezing
  • If you experience moderate or severe chest pain or new chest pain, you should dial 911
  • Frequent morning headaches could be a sign of hypercapnia, an increased level of carbon dioxide in the blood
  • A fever, generally over 101
  • 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
  • Gaining more than two pounds in a day or more than five pounds in a week can signal a worsening of COPD
  • Anxiety and/or restlessness
  • Inability to walk as far as you ordinarily can, or take as many stairs as you ordinarily could
  • Increased need for "breakthrough" breathing treatments
  • Increasing fatigue or weakness

Don’t wait for your COPD symptoms to become life-threatening to seek medical advice. If you experience any of these symptoms, call your doctor promptly to avoid an emergency situation.

Create an Emergency Action Plan

It can be very helpful to plan ahead for emergencies with COPD, as exacerbations are the rule rather than the exception with this disease.

Create a list of your symptoms to bring to your doctor, and ask what she would add knowing your specific condition. 

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 or you to call 911 or call your doctor.

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 policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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