Top 10 Signs of COPD

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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.

More signs of COPD

6. Breathing problems when sleeping or lying down

Waking up in the middle of the night unable to breathe is one telltale sign of COPD, but there are other more subtle indications as well. Some people notice that breathing is impaired any time they lie down; others feel fine at first but wake up feeling like they're suffocating. Those who live with someone with COPD may notice that their loved one is using more pillows to be comfortable at night. Choosing to sleep in a recliner because it's "hard to stay asleep in bed" is something doctors often hear from those with COPD. Coughing may also worsen at night, causing wakefulness.

What's going on: Lying flat forces your lungs to work harder, causing shortness of breath that may be more noticeable than when standing. Breathing difficulties may limit the flow of oxygen to the brain and other parts of the body, causing additional symptoms such as dizziness.

What to pay attention to: Tightness in the chest may be more pronounced while lying down; there may even be pain with inhalation, causing the breathing to be shallow. If your loved one's sleep is disrupted by breathing difficulties or he or she wakes up feeling weak and fatigued from lack of deep sleep, talk to a doctor.

7. Shirts no longer fit

A change of girth is one of the primary symptoms of heart failure, a condition sometimes difficult to distinguish from COPD. But the change in size that accompanies COPD is in the upper chest, which expands outwards with a characteristic "barrel chest" shape.

What's going on: Chronic inflammation causes the lungs to become enlarged and push the diaphragm downward, limiting the muscle's ability to contract. The enlarged lungs also push the chest wall out, weakening the accessory respiratory muscles in the chest and neck and between the ribs.

What to pay attention to: A telltale posture while sitting is to lean forward with arms on the knees. This is an unconscious attempt to ease breathing by engaging the accessory breathing muscles and stabilizing the chest. Doctors often check for COPD by having patients raise their arms over their heads while breathing, which makes the barrel chest shape more evident.

8. Wheezing or whistling while breathing

This symptom can be so prevalent in someone with COPD that it's possible to hear a wheezing or whistling sound even without a stethoscope. The noise is high-pitched, much like the wind when it whistles through cracks in walls. The wheezing can occur during inhalation, exhalation, or both.

What's going on: Airway restriction makes it difficult for air to pass through the bronchial tubes. They may be inflamed, thickened, or blocked by mucus. This symptom also occurs with asthma, so it's important to know the differences between asthma and COPD.

What to pay attention to: Sometimes there's also a gurgling or rattling sound that accompanies inhaling and exhaling, the result of sputum in the airways.

9. Morning headaches

If you or a loved one wakes up morning after morning with a pounding headache, breathing difficulties during the night might be responsible.

What's going on: An inability to breathe deeply during sleep causes carbon monoxide to be retained in the alveoli, the tiny sacs in the lungs. The buildup of carbon dioxide dilates blood vessels in the brain, resulting in headaches.

What to pay attention to: This particular symptom is easiest to identify by process of elimination. There are a few other conditions -- including jaw clenching or bruxism and sleep apnea -- that can also cause post-sleep headaches. But if it's possible to eliminate other problems and the pounding headaches persist, COPD may be responsible.

10. Thickened fingertips

"Clubbing" is the name doctors use for thick, rounded fingertips that curve over slightly. In the beginning, the changes are usually most noticeable in the nail bed, which may feel spongy and soft or may curve downward.

What's going on: Over time, oxygen deprivation begins to affect the extremities, particularly the fingers. Fingernails can have a bluish tone, another sign of lack of oxygen. While oxygen-rich blood is red, blood that contains less oxygen is purplish or blue in color.

What to pay attention to: If oxygen deprivation, known as cyanosis, is the problem, a person may also develop a slight gray-blue tinge to the skin. This is more likely to be picked up by family or friends, who may notice that the person looks unhealthy, washed out, and dusky.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio

3 months, said...

April 1 I celebrate 6 years of no smoking. In the past 2 years I have developed the clear, thick phglem and wheeze when I lay down. IN the past 6 months I have the morning headaches, difficulty breathing bent over and some other issues. At first I thought it was due to the hiatal hernia I have due to GERD but reading thing- I think i have other issues.

9 months, said...

My mom has been a smoker for over 30 years. She has been complaining of this dry hacking cough for years (im sure it's cause of her smoking for so long.) But yesterday I came home from work and my grandmother said she had been sleeping all day, which she has done before but normally is up for dinner. So I was concerned after dinner so I went to check on her and try and wake her up but she wouldn't. She was breathing but had thick bloody brown mucus coming out her nose and mouth. Of course I called 911 and they admitted her to the hospital. But the only thing the doctors can think of what could have happened was she had/have been having seizures. She did have epilepsy as a adolescent but grew out of it which is normal. But from reading a comment on here that sounded like my mom's im just wondering if this happened due to COPD. If anyone has any ideas or think it is COPD please let me know.

9 months, said...

I've had trouble breathing in the past, severe headaches, dizziness. Now, I can't seem to get the phlegm out of my lungs. It all came pretty quick with this symptom. It's as though there's a just a little phlegm that I can never clear. I have 3 Aunts die of respiratory problems and my Uncle ( their brother) just told me he has hospice care coming to his home for COPD.

about 1 year, said...

My grandmother just got surgery and I'm worried about because she just got a hole in her throat im worried if she could pass soon she is Eighty-three years old and im scared and im only 17 years old and im just only worried about my grandmother's health she has COPD and she is a former smoker so im just wondering if she will have a long life span or if she is going to die soon

over 1 year, said...

Recently I have had a very bad shortness of breathe, accompanied with bad wheezing,and cough that produces clear to very dark brown mucus. I have no energy, fatigue regardless of the amount of sleep or rest, and have not had a cold, flu or anything of the sorts. I'm very worried as I have not ever felt this weak in my entire life. I have lost weight and do not have the appetite I once had. Also, and for example, I can simply get up and walk to the bathroom and be out of breathe, as if im almost struggling to get air. I'm not over weight and I am usually very active until the onset of all of this. My heart beats harder and faster than usual, for example when I take my dog for a walk, I simply have to stop and try to catch my breathe and let my heart rate die down a bit. I'm scared, worried and have not been to doctor as I do not have insurance. I do smoke but have nearly quit over the past week due to the severeness of these symptoms I have listed above. Please if anyone has advise or any knowledge as to what may be wrong please email me back. Thanks For Your Time, Gary Joshua Leming

almost 2 years, said...

I just feel like something in my throte and a hack n cough

almost 5 years, said...

Thank you - succint and simple to understand. I wonder if a wedge would help my husband? He tends to curl his head over in his sleep and this blocks his breathing. He also breathes oddly, breathes in and then puffs out, so hard that it shakes the bed. Sadly he says he cannot stop smoking, and will not try any of the aids avaible to help himself, even though he has had 2 pneumothorax, a thoracotomy, popliteal aneurym, bilateral femoro politeal bypasses, TB. I hope I can stay strong to support him through what is to come.

about 6 years, said...

I knew most of this cause of my Mom having COPD for over 15 years, now I'm getting some of the same symtpoms... if I have it I already know my fate and that makes me very very sad..and scared "-(

over 6 years, said...

your site brings such a straight forward view. it makes it so easy to learn and understand in times of need. i always say it...but 'thankyou' again.