Overview

COPD (Chronic obstructive pulmonary disease) symptoms come on subtly at first and you may not realize you are heading for something serious. You can label these initial innocent symptoms as early warning signs.

The major COPD symptoms and signs typically include a cough with or without mucus, shortness of breath, wheezing, and tightness in the chest. Not all patients with these symptoms have COPD and likewise, not all COPD patients exhibit these symptoms.

COPD is a typical disease of adults. When it sets in, it progresses over the years and passes through four stages from mild -> moderate -> severe ->very severe.

In older adults, for example, seniors above the age of 65 years, the symptoms will progress at a faster rate. This is because the immunity and the lungs have weakened with age.

COPD patients can also develop superadded common cold or influenza in which case, the symptoms of flu or cold can overlap. Such patients with flu are more likely to develop its complications. These also worsen in smokers and past smokers.

There are episodes of exacerbations (flare-ups of symptoms), prognosis worsens and life expectancy drops with every progressive stage.

About 50% of people who have advanced to the 4th stage of very severe COPD succumb to it. The appearance of exacerbations requires immediate hospitalization.

As the severity of the disease progresses, the symptoms increase and worsen over time. The

COPD has no cure and it is impossible to describe the timeline progression of the disease. In every patient, the progression varies. It depends on his constitution and his variable exposure to its causes and risk factors.

But, one thing is certain; it takes years and does not end in months. The progression is monitored by periodical spirometry tests and the appearing symptoms.

COPD has become a global epidemic. Its alarming statistics tell you that. To make matters worse, there is no cure. Treatment simply tries to make the patient comfortable, control the symptoms and flare-ups, and slow down its progression.

COPD is an umbrella disease in which chronic bronchitis and emphysema are present. You will, therefore, see symptoms of chronic bronchitis and emphysema.

Chronic bronchitis is defined as when there are bouts of an everyday cough with mucus production thrice or more times a year for two successive years.

The pathophysiology shows inflammation and swelling of the bronchi and the bronchioles (airways and their smaller branches) causing excessive production of mucus. In COPD, chronic bronchitis causes symptoms of cough with sputum and difficulty in breathing.

Emphysema is a condition where the air sacs (called alveoli), which are situated at the end of the bronchioles become damaged and lose their normal physiological structure.

This impairs the normal gas exchange that takes place in the alveoli causing less oxygen and more carbon dioxide levels in the blood.

In COPD, emphysema causes symptoms of cough, shortness of breath, and wheezing, which progress over time.

COPD symptoms and signs in adults

COPD develops over years and you may not develop any symptoms early on. They start to appear after the age of 35 years to 40 years and after significant (about 50%) lung damage. The early symptoms of chronic cough with phlegm appear innocent and the person is likely to ignore them or take some OTC medicine.

And, that is the reason the symptoms worsen with time and the disease progresses in its stages. Recognizing the COPD symptoms, therefore, attains paramount importance. They are described below.

COPD fever

Fever can set in if there is superadded viral or bacterial respiratory infection.

Cough with or without sputum

Cough often referred to as the smoker’s cough is the initial or the early symptom with varying frequency in different people with COPD. Initially, there may or may not be mucus/sputum/phlegm. The cough is due to the substantial inflammation of the airways, which causes increased production of mucus.

The mucus is white in color, but as the disease worsens, the sputum/phlegm/expectoration can become thick and yellow or green in color, indicating a superadded bacterial infection. You may even cough up blood. The blood can come from the throat due to irritation or from the lungs. Chronic bronchitis and emphysema, the two main components of COPD can both cause coughing up of blood.

Coughing is a mechanical method of the body to clear away the extra mucus in the lungs.

Stable COPD patients cough more during the day than at night and it is worst during the morning usually with the production of colorless sputum.

COPD breathlessness and why it occurs

Shortness of breath (called dyspnea in medical terms) occurs due to partial obstruction of the lumen of the airways. It is persistent and often referred to as “air hunger”. This is due to

  • Loss of the elastic nature of the walls of the airways
  • Blockage of the lumen due to inflammation of the cells lining their inner walls
  • Excessive production of mucus and its retention in the airways

Due to increased levels of carbon dioxide and less oxygen in the blood, the body tissues and the organs do not get their required quota of oxygen.

The brain and the body’s complex mechanism tries to compensate by increasing the breathing frequency so that normal oxygen levels are maintained in the blood. This is an involuntary process over which you have no control. But, the lungs are so badly damaged that this mechanism is unable to bring up the oxygen levels.

COPD patients experience shortness of breath at any time of the day but most patients feel more breathless in the morning and at night. 

Initially, dyspnea occurs on exertion. As the disease progresses, dyspnea starts occurring at lower levels of exertion. For example, if, formerly you took the stairs you may now start using the elevator.

Ultimately, with the disease progression, you feel breathless even doing your daily low-level activities such as wearing your clothes. Dyspnea at rest is the final outcome.

This adds to the anxiety of the patient, which again worsens the dyspnea.

The dyspnea of COPD can onset even at night when you are sleeping. It is called paroxysmal nocturnal dyspnea (PND) and refers to attacks of severe shortness of breath and coughing that generally occur at night.

It usually awakens the person from sleep and may be quite frightening. There are, however, other causes of PND including cardiac causes.

Wheezing

Wheezing is a COPD symptom characterized by a high-pitched whistling sound clearly audible when you inhale and exhale. It is also referred to as noisy breathing. It indicates great difficulty in breathing and occurs because of excessive mucus production due to a lung infection.

These inspiratory and expiratory wheezing sounds of COPD heard over the chest are usually chronic and ongoing over a long period of time. You will see them in the advanced stages of COPD. Both, chronic bronchitis and emphysema can cause wheezing.

There are other causes of wheezing besides COPD such as lung cancer, pulmonary edema, heart failure, etc. Wheezing along with rapid breathing can be a symptom of a potentially serious respiratory condition.

An accompanying gurgling sound indicates the presence of fluid in your lungs. These sounds are also called crackles, rales, or crepitations and are heard through a stethoscope. Early inspiratory and expiratory crackles indicate chronic bronchitis.

Dizziness and vertigo

The appearance of dizziness in COPD indicates that your brain and body are not getting enough oxygen. These dizzy spells can come on when you are having a coughing fit or when you have exerted yourself such as walking for too long and too fast.

In short, dizziness comes on when the oxygen requirement of the body increases. This requirement cannot be fulfilled due to low levels of oxygen in the blood.

See your doctor to rule out other non-COPD causes such as hypoglycemia, blood pressure, or some medications.

Headache

The COPD headache starts in the morning while you sleep and is typically dull and throbbing. It is caused by the building up of carbon dioxide in the blood.

Chest tightness

The symptom of chest tightness in COPD often occurs with shortness of breath and wheezing. If one worsens so will the other two.

The symptom of chest tightness is often described differently by the patients.

  • Squeezing of the chest
  • A tight band around the chest
  • Pressure on the chest as though someone is sitting on the chest

The causes of chest tightness symptom are

  • Airway obstruction  (in COPD this is due to excessive mucus)
  • Bronchospasm
  • Repeated respiratory infections

Frequent respiratory tract infections in COPD

The normal healthy lungs have a defense mechanism that allows them to get rid of the secreted mucus and the inhaled pathogens (such as bacteria and viruses) out of the lungs. Read about the COPD pathophysiological changes in the lungs to understand this mechanism.

Due to lung damage, the defense mechanism loses its function. Mucus and bacteria accumulate in the lungs and frequent bouts of acute and chronic lung infections set in.

These frequent respiratory tract infections significantly contribute to the morbidity of the patient and are the cause of COPD exacerbations.

Cyanosis:  Blueness of the lips or fingernail beds

In a normal healthy person, the blood is rich in oxygen due to healthy gas exchange in the lungs. This does not happen in COPD because of the damage caused to the lungs by this disease.

Due to the impaired gas exchange, more carbon dioxide accumulates in the blood with falling oxygen levels. The whole body including the skin suffers due to less oxygen supply. The skin loses its normal color and can acquire a bluish or grayish tinge. This is called cyanosis.

It can be central cyanosis in which case the lips, tongue, and mouth acquire a bluish or grayish color. Peripheral cyanosis causes bluish coloration of the skin of the arms, legs, feet, hands, fingers, and fingernail beds. Both these can be caused by COPD or its complications.

Bluish discoloration of the skin is usually a symptom of the later stages of COPD. It may be present all the time or may come on when the body asks for more blood such as after exercise or some physical activity. It can develop gradually or suddenly. A sudden occurrence indicates an onset of an exacerbation or a flare-up.

COPD symptoms of fatigue or tiredness

Fatigue or tiredness can be defined as a feeling of low energy for daily activities. You may not want to do them or you may not be able to complete them due to a feeling of tiredness.

Why do patients feel fatigued? The main cause is the lack of oxygen in the blood caused by the poor exchange of gases in the alveoli (air sacs) in the lungs.

COPD damages the alveoli by the emphysematous pathological changes in the lung parenchyma. More carbon dioxide and less oxygen in the blood results in the body tissues, muscles, and organs not receiving their quota of nutrition.

Secondly, breathlessness is another issue because you consume a lot of energy to breathe when you suffer from shortness of breath. Normally, breathing is unconscious and effortless. Shortness of breath is a conscious effort burning up ten times more calories.

Thirdly, patients with COPD suffer from a lack of sleep. This is due to:

  • Certain medications given for COPD
  • Attacks of coughing or breathlessness during the night
  • The feeling of anxiety and depression, which is common among COPD patients

Swelling of the ankles, feet, or legs

The symptom of pedal edema or swelling of the ankles, feet, or legs is not caused directly by COPD but is a result of its complications: cor pulmonale and pulmonary hypertension that can set in the later stages.

Pulmonary hypertension raises the blood pressure specifically in the blood vessels in the lungs, making it more difficult for the right side of your heart (this part of the heart pumps blood to your lungs for gas exchange) to consistently pump blood to the lungs against the raised pressure.

This burdens the right side of the heart and over time, it enlarges and ultimately fails. This is called cor pulmonale.

Due to this failure, the pumping action of the heart weakens and blood circulation slows down causing blood to build up in the peripheral veins of the lower extremities. Fluid leaks out of the veins into the surrounding tissues, which causes swelling in the lower extremities.

Unintentional weight loss

In the later stages of COPD, the patient starts losing weight without even trying to. 40% to 70% of COPD patients lose weight without planning to. About 25% of them can be graded as thin.

The patient begins to lose weight in the later COPD stages when the degree of the disease is severe. There are several reasons why the patient loses weight.

1.      In the final stage, the lungs increase in size due to the severe inflammation in them. This causes them to push against the adjacent stomach, thereby reducing the volume of the stomach. You cannot eat your normal quota due to this reduced space in the stomach.

2.      In normal healthy people, breathing is unconscious and effortless. The hard breathing of COPD consumes a lot of calories. According to Cleveland Clinic, breathing due to the damaged lungs of COPD can burn 10 times more calories than normal breathing.

  1. Mental anxiety and depression, which is commonly seen in COPD patients cause loss of appetite and the patient does not eat half as much as he used to eat before. This also causes fatigue and tiredness during the day.

More calories burnt and less calorie intake cause this unplanned weight loss in COPD patients.

COPD and the barrel-shaped chest

It is the emphysema in the COPD patient, which causes the shape of his chest to become rounded and bulging. This is the symptom and sign of the later stages of COPD.

Emphysema causes damage to the alveoli, which lose their elasticity. During expiration, therefore, the air inhaled is not completely exhaled and a portion of it is retained in the lungs.

As this is chronic, the lungs stay overinflated all the time and the ribcage stays partially expanded. This gives the chest a barrel-shaped appearance. A barrel chest can aggravate the shortness of breath and the patient feels breathless even at rest.

Morning and night COPD symptoms

All the classic symptoms of COPD may not be present in the patient. Secondly, while you feel the symptoms throughout the day, some occur more in the morning and some are more pronounced at night.

The major morning symptoms include dyspnea, phlegm, and cough, while you will see dyspnea, wheezing, and chest tightness during the night.

COPD symptoms of end-stage

COPD symptoms worsen as the disease advances stage-wise. The end-stage symptoms tell the doctor of impending death and a short survival time that may last for a few days.

These symptoms include

  • Worsening of dyspnea
  • Cough
  • Disorientation and confusion
  • Hypersomnia is characterized by excessive daytime sleepiness
  • Altered and irregular breathing
  • Cool extremities
  • Speckled skin
  • Impaired production of urine
  • Changes in vital signs such as  body temperature, blood pressure, pulse, and breathing rate
  • Loss of interest to eat or drink water

Do children suffer from COPD symptoms?

COPD is not a well-defined disease in children. Children may show COPD-like symptoms such as cough with sputum, wheezing, and shortness of breath, but they are likely to be due to an allergic, viral, or bacterial cause.

However, children who suffer from asthma and are constantly exposed to smoke and other air pollutants become potential candidates to suffer from COPD in adulthood.

Can nonsmokers develop COPD symptoms?

Ninety percent of COPD cases are caused by smoking. So, it is rather surprising when a nonsmoker presents with COPD.

A nonsmoker who is regularly exposed to pollution in the air with chemicals, dust, fumes, or occupational gases is at a very high risk of developing COPD.

Secondly, another cause in non-smokers could be genetic, where he suffers from a deficiency of Alpha-1 Antitrypsin protein in the bloodstream. This type of COPD is referred to as Alpha-1 Antitrypsin-related COPD.


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