Top 10 Signs of COPD

Few things are as scary as not being able to breathe. Yet COPD can come on so gradually that by the time patients realize they're in trouble, a lot of damage has already been done. In fact, an estimated 16 million people in the U.S. have been diagnosed with COPD, and the American Lung Association estimates there are another 10 million people with COPD who don't know they have it. Yet finding out you have COPD and starting treatment is key to slowing progression of the disease. Here are the top 10 signs of COPD.

1. Coughing all the time but you don't feel sick

"I have this cough that just won't go away" is probably the number-one complaint doctors hear that triggers a workup for COPD. It may be exactly like the cough you typically get with the flu, except you don't have a fever or any other symptoms. The cough may be dry, but more likely it's a wet cough that brings up mucus.

What's going on: Narrowing and inflammation of the airways lead to overproduction of mucus, triggering a chronic phlegmy cough. Because the mucus blocks the airways even more, it feels like you have to cough all the time. Changes of temperature, the strain of physical exertion, and exposure to irritants (such as a dusty room, pet dander, smoke, or exhaust) may trigger coughing fits.

What to pay attention to: Note how long you've been congested, the color of the mucus, and whether you have a cold or allergies. The congestion associated with colds and flu typically doesn't last longer than a couple of weeks. The congestion associated with allergies usually occurs in response to a trigger, such as seasonal pollen. Typically, the mucus associated colds and allergies is clear.

The mucus associated with COPD may also be clear or yellow, but it's likely to be thicker. And it may be greenish, brownish, or have blood in it -- signs of a worsening condition, says Byron Thomashow, professor at Columbia University Medical School and chairman of the board of the COPD Foundation. Coughing all the time without sputum can also be a sign of COPD, particularly in active smokers.

2. Repeated bouts of cold and flu

There's an unfortunate circular relationship between viral and bacterial respiratory illnesses and COPD. Getting frequent colds or flu -- and not being able to shake an illness quickly after getting it -- is a common sign of COPD. It's also true that repeated bouts of respiratory illness, particularly bronchitis and pneumonia, can be a cause of COPD or at least can accelerate the progression of the disease.

What's going on: When the bronchial tubes are scarred, which happens over time as a result of inflammation, they become an ideal breeding ground for infections, particularly bacterial infections. According to a report by the National Institutes of Health, chronic bronchitis is often overlooked because people believe it's not life threatening and they'll get well by themselves; by the time they see a doctor, long-term damage has been done. In those already diagnosed with COPD, getting a cold or other respiratory illness is the most common trigger for a flare-up or exacerbation.

What to pay attention to: Any changes in the typical course of illness. People who never used to get sick should pay attention if they start getting repeated colds and the flu every winter, says Thomashow. Those who used to shake off a cold quickly should pay attention if every illness lingers for weeks. If every virus seems to progress to pneumonia, that's definitely a danger sign. Seeking treatment quickly is important to prevent inflammation from further damaging the airways.

3. Constant throat clearing

The near-constant "ahem" of throat clearing can be a constant source of irritation, but it's more than that. If you or someone you love has this symptom without the underlying cause of an illness or infection, it could be a warning sign of COPD.

What's going on: A heavy mucus or phlegm is the body's response to irritation and inflammation in the bronchial tubes. When irritation persists over a long period of time, excessive mucus is produced constantly, the lining of the bronchial tubes thickens, and throat clearing becomes an automatic response.

What to pay attention to: In this situation, the reactions of others can be a clue. COPD patients and their family members say the throat clearing can be unconscious. Others may be aware that the problem has become chronic, while the person with COPD attributes it to illnesses and outside circumstances, such as cold temperatures. It's important to notice if certain situations cause increased sputum production or if symptoms worsen, and to bring all changes to a doctor's attention.

4. Inability to catch your breath

Shortness of breath can be a difficult symptom for people with COPD to describe; some say it feels like they can't "catch their breath," some feel they can't breathe deeply enough, some have a dizzy feeling, as if they can't get enough oxygen, such as might be experienced at high altitude. It can also feel like a tightness or compression in the chest, as if something is constricting the lungs and preventing them from inflating.

What's going on: The sensation of being short of breath is actually lack of oxygen as the lungs lose their ability to transfer oxygen to the bloodstream, says Norman Edelman, chief medical officer of the American Lung Association. The lungs are made up of tiny air sacs known as alveoli, where oxygen from the air is exchanged for carbon dioxide in the blood. As the delicate walls of the alveoli become damaged, holes can develop in the tissue and eventually the sacs themselves are destroyed, leaving the lungs with less capacity and less elasticity, which is needed to keep airways open.

What to pay attention to: Some people notice specific limitations, such as not being able to breathe while being bent over to tie their shoes or pick something up off the floor. Also pay attention to activity level and tolerance over time. If it used to be easy to walk up the driveway and now it requires three stops to catch your breath, this is the kind of important detail to describe when seeking treatment.

5. Lack of appetite

When you can't breathe well, it can affect many other bodily functions in surprising ways. One of these is eating. Some people with COPD find they don't notice hunger cues, feel full easily once they begin eating, or lose their appetite. Some people with COPD begin to notice that foods don't taste the same as they used to, or they may feel they're losing their sense of taste altogether.

What's going on: As the lungs struggle to fill with air, it can affect surrounding organs, putting pressure on the abdomen and stomach. Some medicines affect taste and appetite, so check with the doctor to make sure this symptom isn't a side effect from a medication.

What to pay attention to: Sometimes, because breathing is more work, chewing and swallowing and breathing all at once is taxing. Experiment with soft foods that don't require much chewing, and cut food into smaller pieces and see if that makes a difference in appetite.