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.
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.
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
A 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, 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.
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.
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.
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.
Recurring Respiratory Infections
While chronic respiratory infections can tip you and your healthcare provider 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 healthcare provider 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 pulmonary 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 fatiguedLethargy (you won’t have any energy)SleepinessA bluish tinge to your skinConfusion
As the disease progresses, efficiency of gas exchange in the lungs generally declines, leading to worsening symptoms, disability, and severe illness.
If you already have COPD, know that your disease can progress and that exacerbations are the rule rather than the exception with this disease.
Signs of Worsening COPD
If you have already been diagnosed with COPD, you need to be closely monitored by your healthcare provider 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.
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Call your healthcare provider if you develop:
A worsening cough, either in frequency or severityA change in the amount or color of your sputumBlood when you coughIncreased shortness of breathShortness of breath on awakeningNeed to elevate your head more than usual to sleepIncreased wheezingFrequent headachesA fever over 101 degrees FSymptoms of the flu such as a fever, body aches, and sore throatIncreased swelling in your legs, especially if it is not relieved with elevationWeight gain of more than two pounds in a day or more than five pounds in a weekUnintended weight lossAnxiety and/or restlessnessInability to walk as far as you ordinarily can, or take as many stairs as you ordinarily couldIncreasing fatigue or weaknessIncreased need for breathing treatments
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.
If you or your loved one have any of the following symptoms, seek immediate medical attention:
Severe or sudden shortness of breathDifficulty speaking due to shortness of breathConfusion or forgetfulnessExtreme fatigue and decreased alertnessDifficulty waking from sleepChest painRapid heart rateBlue fingers or lipsCoughing up more than a teaspoon of blood
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.
