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What Are the Signs and Symptoms of COPD?

For Patients

COPD can cause breathlessness (also called shortness of breath or dyspnea), cough, production of mucus/sputum/phlegm and tiredness (also called fatigue). Symptoms such as breathlessness and fatigue cannot be seen or easily measured because they are sensations or feelings that you experience. Only the person experiencing the symptom can describe these sensations and how badly they make them feel.

When symptoms first occur, most people ignore them as they think that they are related to smoking, i.e. "It’s just a smoker’s cough" or "I’m just winded/breathless from being out of shape". These symptoms can worsen to the point that people are motivated to stop smoking in order to control the symptoms. Others let the symptoms control them. These signs and symptoms of COPD (breathlessness, tiredness, cough and sputum production) are an indication that the lungs are not normal, even though the lungs are actually responding "normally" to the irritation. Many people with COPD develop most, if not all, of these signs and symptoms.

Is coughing a symptom of COPD?

Cough can be expected with COPD. Cough is a natural reaction of the airways to try and remove mucus or it can be a reaction to protect the airways from inhaled irritants. Coughing is therefore a good thing when it results in moving sputum or phlegm out of the breathing passages. For this reason, you will sometimes find your healthcare provider unwilling or hesitant to give you anything to prevent you from coughing. Conversely, cough resulting in airway spasm is not useful over a long period of time, but can be controlled with cough "suppressants". While a person with COPD will often cough, coughing does not mean you have COPD.

What can I do to treat cough?
Cough due to irritants can sometimes be controlled with "over-the-counter" (not needing a prescription) remedies like throat lozenges and cough syrups. Cough due to smoking will probably not go away unless the person stops smoking. If treatment with over-the-counter medications does not control the cough, your provider may prescribe medication. Coughs that are due to thick, sticky mucus can be treated by drinking plenty of fluids. Fluids can help loosen and thin the mucus. If fluids do not work, a cough expectorant or mucolytic may loosen the secretions. Coughing that produces spasm may require an inhaled bronchodilator and/or inhaled steroid. Coughing that does not produce mucus or that becomes violent and difficult to control will usually subside with cough suppressants (also called antitussives) such as codeine. Many people forget that simply drinking more fluids is often the best treatment for a cough.

When should I call my healthcare provider about my cough?
Most coughing is not dangerous. People without COPD should consider seeing their provider if they have a cough that has lasted several weeks or a cough without a known reason (for example, the common cold). In addition, people with certain conditions, such as a collapsed lung or hernias, may be advised by their provider to control their coughing with medications.

Incontinence (inability to control passing urine during cough) may be another problem caused by coughing. Urinary incontinence during cough may occur more frequently in men who have had their prostate removed. Controlling the cough will reduce incontinence. Emptying the bladder more frequently than usual (e.g. every 2 hours) may also reduce incontinence. Pelvic muscle exercises are available and have been found to be useful in those with chronic problems with incontinence (www.utdol.com). Unexplained cough or coughing that causes you to "pass out" should be reported to your healthcare provider. Cough that does not go away with inhaler treatment should also be reported.

Is shortness of breath (breathlessness) a symptom of COPD?

Yes, shortness of breath, also known by the term breathlessness or the medical term of dyspnea, is a common symptom of COPD. Breathlessness is a feeling occurring when the lung changes from working in the way it was normally designed to work, to working differently. If the lung senses that it takes more work or effort to move air in and out of the lungs, a feeling of breathlessness will be experienced. While this feeling can be very uncomfortable to the person with COPD, it does not mean that the person is further damaging their lungs by doing things that make them breathless. Unfortunately, people try to avoid this feeling by doing fewer activities or activities less often. This strategy of avoiding activities to avoid breathlessness may work initially, but eventually avoiding activities leads to getting out of shape or becoming deconditioned. Becoming deconditioned can result in even more shortness of breath with activity. One of the greatest challenges for people with COPD is learning to continue leading an active life in spite of the difficulties breathing. Pulmonary rehabilitation programs are useful in helping people learn strategies to reduce this feeling of breathlessness with activities. An important principle for people with COPD to learn is to never avoid an activity because it causes breathlessness. To do so means COPD has taken control of you and you have lost control over your breathing problem.

What can I do to treat breathlessness?
If you and your provider find that your breathlessness is from your COPD, you can do several things. First, be sure you are taking your medications when and how prescribed, even if you don’t "feel" that they are helping. Secondly, begin a regular program of exercise to build up your strength. Thirdly, learn about paced breathing and ways of breathing more efficiently with activities. These techniques are taught in pulmonary rehabilitation programs. Fourthly, if you find the support of others with the same problem helpful, enroll in a pulmonary rehabilitation program or begin attending breathing support groups offered by your local lung association or clinic.

When should I call my healthcare provider about my breathlessness?
Anytime a person has a new symptom, or the symptom worsens for no known reason, you should consider calling your healthcare provider. Describe to your provider when the breathlessness started, how long it lasts and what makes the breathlessness better or makes it worse. Providing information of this kind can help your provider determine the best steps to take in making you more comfortable.

Is sputum production a symptom of COPD?

Sputum production, also called phlegm or mucus production, can also be a symptom of COPD. Sometimes, people confuse sputum with the mucus coming from their nose, which has drained from their sinuses. Sinus drainage from the nose may drip down the back of the throat to the trachea, where it may "mix" with mucus coming from the lungs. When your provider asks about sputum production, they are usually asking about the amount coming from your lungs, not your sinuses.

It is normal for the airways to produce several ounces of sputum a day. This mucus is needed to keep the breathing passages moist. When the lungs are bothered by irritants, they try to protect themselves by producing additional mucus to trap any inhaled particles from entering the lungs. Constant attack by irritants, such as smoke, however, makes these glands enlarge and produce two to three times the normal amount of mucus. Chronic irritation also causes a problem with the natural cleaning system in the airways provided by the cilia.

Cilia are destroyed by smoking. Smoking also causes any surviving cilia to become paralyzed for at least 20 minutes following inhalation of cigarette smoke. The result is a poorly working sweeping system that doesn’t clear the air passages very well.

Clearing mucus can be a problem for people who are very weak from illness or if they take medications that make them sleepy. Sometimes medications are needed to loosen the mucus so that the mucus can be coughed out more easily. It is possible that sputum that is allowed to accumulate in the lungs may "grow" bacteria, which can cause acute bronchitis or pneumonia.

What can I do to treat my problem with sputum?
The first thing to remember is that sputum needs to be coughed up. Swallowing small amounts of sputum is not known to cause health problems. However, it is better to cough the sputum into a disposable tissue so that you can see the color of the sputum. Knowing the color and amount of sputum you raise on a daily basis is helpful to the person treating your COPD.

There are usually three types of treatment needed for sputum problems:

  1. expectorants, which make the sputum easier to cough out;
  2. mucolytics, which thin thick mucus and;
  3. antibiotics, which treat infections in the lung.

A person with COPD may not need any of the three treatments listed above. A common problem for people with COPD is thick sputum, making sputum difficult to cough up and out. Thick sputum may come from a need to increase your fluid intake. The most natural way of thinning mucus is by drinking any type of non-dehydrating liquid, such as water, juices, etc. These will help make the sputum thinner and easier to cough. Since alcohol, coffee and tea are dehydrating, they should be avoided as a means of liquefying mucus. A person with sputum production should drink at least eight glasses (2 quarts/liters) of liquid a day.

If this natural way of thinning mucus does not work, then medications may be used. Expectorants are medications that may help make the mucus looser. Not all medical scientists, however, are convinced that they work. The most common type of expectorant is a substance called guiafenesin. Another approach is to use medications that break up the sputum molecules, called mucolytics. The most common type of mucolytic is a medication called N-acetylcysteine. This medication is available in inhaled form and must be delivered by a nebulizer. N-acetylcysteine is more commonly prescribed to patients in European countries than in the USA.

The use of antibiotics is reserved for sputum that is infected. Sputum that is clear in color is usually not infected. Sputum that is colored light brown, but which you can see through, may be discolored from diet, such as drinking coffee. However, infected sputum (and therefore infected lungs) is likely if the sputum is a deep yellow color that cannot be seen through. Other colors that may indicate an infection is developing are green, brown or reddish mucus.

When should I call my healthcare provider about changes in sputum?
Generally, a change in the color and the amount of sputum is a sign that there is some abnormal activity in your lungs. In some instances, these changes are so predictable (occurring once or twice a year) that the patient with COPD and their provider can establish a system of treatment that the patient can start at home. For example, seven days of antibiotics and steroids may be prescribed for the patient to begin as soon as signs and symptoms of an infection begin. In most instances, the sputum can tell the person a great deal about what is happening in their lungs, maybe even hours to days before a severe infection develops. It is believed that people who can recognize and treat an infection early can avoid a more serious problem needing hospitalization.

Is tiredness or fatigue a symptom of COPD?

While tiredness or fatigue can be very uncomfortable, it is not dangerous since it is not damaging your lungs or other organs. Tiredness may, however, be a symptom of another condition. Like breathlessness, tiredness is an uncomfortable feeling. It is a common symptom in people with COPD. Tiredness is a feeling of loss of energy or stamina. Generally, breathlessness and tiredness go hand in hand and they are, for some people, difficult to tell apart. Tiredness discourages people from keeping active, which leads to greater loss of energy, which leads to more tiredness. When this cycle begins it is sometimes hard to break. It is estimated that for every day a person is hospitalized, it takes 3-4 days to regain their stamina. Tiredness, like breathlessness, can be prevented or reduced by keeping active and learning how to do activities with less effort.

What can I do to treat tiredness?
If you and your healthcare provider find that your tiredness is from your COPD, you should take the same measures as with breathlessness; make sure you are taking your medications as prescribed, begin a regular program of exercise to build your strength, learn about paced breathing and ways of breathing more efficiently with activities and consider learning from others with the same problem by attending breathing support groups offered by your Lung Association or enrolling in a pulmonary rehabilitation program.

When should I call my healthcare provider about my tiredness?
Call your healthcare provider when unexpected tiredness occurs and does not go away. Ask yourself similar questions that you would with breathlessness. Have you ever had this type of tiredness before, what happened? Anytime a person has a new symptom, or the symptom worsens for no known reason, they should consider calling their healthcare provider. Describe to your provider when the tiredness started, how long it lasts, what makes the tiredness better or makes it worse. If you have ever had this type of tiredness before, what happened? Did any medication help or did you need to be hospitalized? Providing information of this kind can help your provider figure out the best ways to make you more comfortable.

Is wheezing a symptom of COPD?

Wheezing is a sign that air is trying to flow through a narrow passage and it may indicate that the lungs are getting out of control. Airway narrowing can occur from spasms, swelling or mucus accumulating in the airways. Sometimes, when a person with COPD develops an infection in their lungs, wheezing may occur. This wheezing should be controlled with medications so that the wheezing lessens and finally is no longer present. If wheezing worsens or cannot be controlled with medication, call your healthcare provider.

What can I do to treat wheezing?
Taking your bronchodilator medication regularly should control wheezing. Avoid things that cause wheezing, such as smoky places or, if cats or other things cause you wheezing, avoid them. Usually wheezing does not go away without treatment.

When should I call my healthcare provider about my wheezing?
If wheezing and breathlessness do not go away with the medication you have been given, call your healthcare provider. If these symptoms become severe, seek emergency treatment.