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.