Symptoms of Chronic Obstructive Pulmonary Disease (COPD)

Understanding The Common Symptoms of COPD

What are the common symptoms of chronic obstructive pulmonary disease (COPD)? One of the most important aspects of managing COPD is the early recognition of symptoms. It's been found that those who are diagnosed and begin COPD treatment earlier in the course of the disease may have a better prognosis. For this reason, if any of the following COPD symptoms sound familiar, contact your healthcare provider for further evaluation.

COPD symptoms can range from mild to very severe, depending on the stage of the disease. While the disease is often slowly progressive, it is common to have COPD exacerbations during which the symptoms worsen for a time. Recognizing the worsening of symptoms which may suggest a COPD exacerbation promptly may also improve outcomes with the disease.

Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by airflow limitation into and out of the lungs that is not fully reversible. This is in contrast to asthma in which airway obstruction is completely reversible with treatment. It is also different from lung diseases which are "restrictive" such as pulmonary fibrosis.

The most common cause of COPD is smoking, but there are several other risk factors as well, such as occupational exposures, secondhand smoke exposure, a hereditary problem known as an alpha-1-antitrypsin deficiency and more. It's important to note that nonsmokers can, and do, develop COPD.

 

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Man carrying portable oxygen for his COPD
What are the symptoms and signs of COPD?. Photo c Leigh Schindler/istockphoto.com

Shortness of breath referred to by the medical term "dyspnea" is the hallmark symptom of COPD. Shortness of breath due to medical conditions can be described in many ways, but many people with COPD describe dyspnea as a sensation that requires an increased effort to breathe, gasping or difficult, or labored breathing. Other people describe the sensation as "air hunger."

Initially, people with COPD may only experience dyspnea when they exert themselves. As the disease progresses, it may occur even while 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.

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

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Smoker's Cough
A chronic cough is a common symptoms of COPD, especially chronic bronchitis. David Freund/istockphoto.com

A chronic cough in COPD is one that is long-term and doesn't seem to go away. Medically, it is 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 causes of a persistent cough as well, and it's important to make sure these other possibly serious causes are ruled out.

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

A cough with COPD can be dry (non-productive) or productive of mucus. With some types of COPD, such as chronic bronchitis, the cough occurs daily and is associated with mucus production.

Patients can have a chronic cough that is productive, meaning it produces mucus, or it can be non-productive, where no mucus is produced. Initially, the cough may be intermittent, but as the disease progresses, it may be present every day.

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drawing of a cupped hand illustrating postural drainage, a method of removing sputum
Sputum production is common in people with COPD.

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

People with COPD often produce small amounts of tenacious sputum when they cough. Causes of increased mucus production 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 which work in a wave-like fashion to move substances caught in phlegm up into the mouth to be swallowed.)

A copious 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.

There are several airways clearance techniques that can be used to help bring up sputum, such as postural drainage.

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Chest X-Ray
Wheezing and chest tightness can be symptoms of COPD. Photo courtesy of Getty Images, user Ian Waldi

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

Tightness in the chest is often described as a feeling of pressure within the chest walls that makes automatic breathing difficult. Chest tightness may be present when there is an infection in the lungs and it may make deep breathing painful (pleuritic chest pain) causing respiration to be short and shallow. It is important to note that an absence of these symptoms does not exclude, or confirm, a diagnosis of COPD.

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stressed man leaning against a brick wall screaming
Fatigue is an annoying symptom for those with COPD. Photo courtesy of Getty Images, user GSO Images

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 of sleep. While dyspnea is the most worrisome symptoms among those with COPD, fatigue can be one of the most annoying. It's more than annoying, however, and fatigue associated with COPD increases the risk of hospitalizations.

Overall, fatigue is three times more common in people with lung disease than in those without lung disease.

Check out these tips for managing fatigue related to COPD.

Different than ordinary tiredness, fatigue is a symptom that is often poorly understood and many times underreported in COPD as the focus tends to fall on more recognizable symptoms like a dyspnea and chronic cough. But because fatigue is nearly 3 times greater in those who have lung disease than in healthy people, it is an important symptom to recognize.

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Malnutrition
Weight loss and appetite are important symptoms which should be addressed with COPD. Photo Courtesy of Flickr.com, user Ruta

Anorexia is common problems in COPD, often occurring 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. Cachexia is a condition which includes both weight loss and muscle wasting and is a significant cause of death in people with many chronic diseases.

Both anorexia 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. COPD is a strong independent risk factor for lung cancer, meaning that it raises the risk even if a person has never smoked.

Nutrition is important for anyone, but especially with COPD. Many pulmonologists now recommend nutritional counseling for their patients with COPD, and if this has not been recommended, you may wish to ask for a referral. In the meantime, check out our guide to nutrition for people with COPD.

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Emotions such as anxiety, depression, and even panic disorder are common with COPD.

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.

Medications and other non-pharmacological treatments are available that can help reduce the anxiety and depression associated with COPD, sometimes completely. If you suffer from either symptom, or both, or are noticing any other emotional effects of your disease, talk to your healthcare provider about your treatment options.

Panic attacks are also very common among people with COPD and can lead to a vicious cycle when combined with shortness of breath. Learn about some of the ways to manage panic attacks in COPD even if you don't have full-blown panic attacks.

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A Last Word About COPD Symptoms

COPD Triggers
What else should you know about COPD symptoms. Photo courtesy of Getty Images, user Paul Burns

According to the Global Initiative for Obstructive Lung Disease, the hallmark symptoms of COPD are progressively worsening dyspnea, chronic cough, and sputum production. However, cough and sputum production may be present long before airflow limitation, one of the primary characteristics of COPD, develops.

In contrast, airflow limitation can develop without a chronic cough and sputum production. If you notice that you have any of the COPD symptoms mentioned here, and you have a history of exposure to COPD risk factors or a family history of COPD, it is important to be further evaluated by your healthcare provider.

A diagnosis of COPD can sometimes be difficult as there are many other medical conditions in which the symptoms listed above occur. Take a moment to check out the differential diagnosis of COPD, to learn about what other conditions which may mimic these symptoms.

Finally, whether you are diagnosed with COPD or another condition, be your own advocate in your health care. Medicine is changing rapidly and is it difficult for anyone to keep up with all of these changes. New research on COPD is published every week. Taking an active part in your medical care is not only empowering but may affect your outcome as well.

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