A Comprehensive Guide to COPD Complications

When you have chronic obstructive pulmonary disease (COPD), the complications of your condition can be serious and even life-threatening. To safeguard your own health, it's important to learn the signs and symptoms of these possible complications, ranging from shortness of breath and exacerbations to pulmonary hypertension and collapsed lung.

To reduce your risk of developing other health issues when you have COPD, it's also key to closely follow your healthcare provider's plan of care.

This detailed overview of possible complications you might experience with COPD is a good place to start. Be sure to speak with your healthcare provider about which might be of particular concern for you.

Man using an asthma inhaler
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Acute Exacerbation of COPD

In its simplest terms, an exacerbation is a flare-up of your COPD symptoms. You might have more trouble breathing than you normally do, your cough might worsen, or you might have more mucus. Some people may also have a fever with an exacerbation.

Exacerbations are often caused by infection, but in some cases inflammation increases with no known cause. Many people with COPD suffer several episodes of acute exacerbation a year, often leading to increased hospitalizations, respiratory failure, and even death, as oxygen levels may drop to dangerously low levels.

When you're having a COPD exacerbation, you may need to be admitted to the hospital, or you might be able to manage at home with the help of a homecare nurse. Treatment may include medications such as inhalers, steroids, and antibiotics, along with oxygen therapy and positive airway pressure machines (PAP) such as CPAP.

It may take a month or more to recover from an exacerbation.

If you start to notice increased fatigue, shortness of breath, swelling, or a change in mucus consistency, be sure to seek help immediately. It could be an acute exacerbation of your condition, or it could be a sign of a more serious complication.


Depression is a relatively common complication of COPD as, for many, the disease has far-reaching effects into every aspect of daily life and, unfortunately, the condition is often irreversible. Because fatigue plays such a major role in COPD, it can cause feelings of sadness and loss of enthusiasm or interest in everyday activities.

One study found that among 76,000 subjects, half of those diagnosed with COPD were twice as likely to have depression as those without the disease.

If you're having trouble sleeping, experiencing feelings of sadness, experiencing fatigue that prohibits you from doing things you used to enjoy, or if you've started to lose interest in food, be sure to seek care from a mental health professional. They will be able to equip you with actionable tools to help manage any potential depression.


Frailty refers to a weakened physical state, including weight loss, muscle wasting, general fatigue, and bone loss. The shortness of breath often seen in COPD can make eating difficult, and fatigue may drastically reduce physical activity levels, resulting in muscle wasting.

Additionally, steroid courses are often prescribed for people battling COPD, and one side effect of these medications is thinning or weakening bones. Steroids negatively affect calcium and vitamin D metabolism, which means the body is forced to pull calcium from its stores, resulting in weakened bone structures and an increased risk of fracture.

Keep up with bone health by consuming calcium-rich foods such as dairy products, leafy greens, nuts, and seeds, and do your best to stay active by incorporating regular walking and strength-bearing exercises such as gentle yoga or light weight-lifting into your daily routine.

Pulmonary Hypertension

Pulmonary hypertension occurs when there is abnormally high pressure within the blood vessels of the lungs.

Normally, blood flows from your heart to pass through your lungs, where blood cells pick up oxygen and deliver it to the body. In pulmonary hypertension, the blood vessels in the lungs become thicker and narrower. This means less blood is able to flow through them. Pressure rises and your heart muscle has to work harder to get the blood through the lung's blood vessels. Ultimately, less oxygen reaches your body due to pulmonary hypertension.

Symptoms of pulmonary hypertension include chest pain, shortness of breath, lightheadedness, heart palpitations, and swelling of your belly, ankles, or feet.

Treatment options for pulmonary hypertension include vasodilators (medications that open the blood vessels), blood pressure medications, inhalants, and diuretics to reduce swelling. But to ultimately treat the root cause of pulmonary hypertension, your healthcare provider may recommend a pulmonary rehabilitation program to help you get your COPD under control.

Cor Pulmonale

Cor pulmonale is heart failure on the right side of your heart—the side that pumps blood from the organ to your lungs. The condition is caused by an increase in blood pressure in your pulmonary artery, which is the main route for blood to travel from the right side of your heart to your lungs.

Elevated blood pressure in this artery can strain your heart muscle on the right side. This then causes the right side of your heart to become enlarged and to develop heart failure, which means it can't pump blood properly.

Symptoms of cor pulmonale are similar to those of COPD and include trouble breathing, inability to exercise, and swelling of the feet and ankles. Treatment usually involves blood pressure medications, diuretics to reduce any swelling, and oxygen therapy. In very advanced cases of cor pulmonale, heart or lung transplant may be required.


A pneumothorax is an accumulation of air or gas in the space between the lung and the chest wall. It occurs because of a hole that develops in the lung, which allows air to escape. This causes the lung to partially or completely collapse.

People who have COPD are at greater risk for a pneumothorax because the structure of their lungs is weaker and more vulnerable to the spontaneous development of these types of holes.

Symptoms of a pneumothorax include sudden, sharp chest pain; chest tightness; and rapid heart rate. A small pneumothorax may go away on its own, but if your pneumothorax is large, you may need to be admitted to the hospital for a procedure to drain the air from your chest and re-inflate your lung.

Respiratory Failure

Respiratory failure occurs when your lungs aren't doing a proper job of transferring oxygen to your blood and removing waste carbon dioxide from your blood. There are numerous possible causes of respiratory failure, including COPD and pneumonia.

Symptoms of respiratory failure include shortness of breath, extreme tiredness and fatigue, confusion and rapid breathing. When these symptoms develop suddenly, they're a medical emergency.

Treatment of respiratory failure usually involves medication and oxygen therapy.

Secondary Polycythemia

Secondary polycythemia is a rare disorder where there are too many red blood cells in your blood. When this occurs, your blood becomes thick, which makes it difficult for the blood to flow through your smaller blood vessels.

In people with COPD, secondary polycythemia can occur as the body tries to compensate for decreased amounts of oxygen in the blood. Symptoms of secondary polycythemia include weakness, headache, and fatigue.

Getting COPD under control should bring secondary polycythemia under control as well. In the interim, your healthcare provider may recommend some measures to relieve your symptoms.


Cyanosis is a condition in which your blood oxygen levels have fallen drastically low and your body has difficulty getting enough oxygen to your extremities. This results in a blue or grayish cast to your skin, especially your lips and the area around your eyes.

Cyanosis may be a symptom of an urgent medical issue and should be treated immediately. If you or a loved one are exhibiting signs of cyanosis, call 911.

Your provider will confirm your blood oxygen levels with pulse oximetry, and you may need medical-grade oxygen therapy to help re-oxygenate your blood.

A Word From Verywell

COPD is a chronic condition that may progressively worsen over time, which is why it's so important to regularly monitor your condition and have regular checkups with your healthcare team. That said, there are still many ways to prevent COPD complications through healthy lifestyle habits. Along with getting regular vaccinations against flu and pneumonia and keeping up with your medications, incorporating gentle movement, adequate sleep and hydration, and following a healthy diet can go a long way in maintaining your health for years to come.

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.

By Deborah Leader, RN
 Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD.