COPD Symptoms

COPD Symptoms

The key to managing your symptoms is to recognize them and know what you can do about it.

Chronic obstructive pulmonary disease (COPD) is a long-term, progressive disease, meaning that symptoms begin gradually and get worse over time.

 

Obstructive lung disease means that there is something in the way of the normal flow of air. In the case of COPD, this obstruction is caused by mucus and inflammation—and it leads to a range of symptoms.

 

Depending on the stage of COPD, a person may experience a variety of symptoms. Here are some of the most common and bothersome symptoms and some tips on dealing with them.

Chronic Cough

Coughing is a natural defence mechanism to remove mucus and other irritants from the lungs. However, many people with COPD experience a constant recurring cough.

This is because they have more mucus in their lungs than a person without COPD, and they are constantly producing this mucus.

What you can do about it: Managing coughing requires a multi-pronged approach.

• It’s important to maintain the air quality in the home by reducing buildup of irritants like dust, dander, and smoke.

• When used correctly, humidifiers can also help maintain the perfect level of moisture in the air, which helps to efficiently expel mucus when coughing.

• Using controlled coughing and huffing techniques can help manage chronic coughing by making each cough more effective and efficient. Controlled coughing and huffing help loosen and bring up excess mucus, and a visual demonstration of these techniques can be found here.

High Mucus Production

People with COPD often have increased mucus production due to inflammation of the airways.

When the airways are inflamed, cells produce more mucus as a natural reaction. If a person has high mucus production, they will constantly feel the need to get rid of it, which can lead to chronic cough. Over time, chronic mucus production can damage airways and reduce lung function (which is how well your lungs work for your breathing).

 

What you can do about it:

 

• It’s important to clear mucus with controlled coughing to prevent excessive buildup.

• Some people use over-the-counter mucus looseners (guaifenesin-containing medications). While there is no scientific evidence to confirm if these are truly effective, some people have reported improvement in symptoms, so speak to your doctor or health care provider before using one.

• There are also mucus-clearing devices using Oscillating Positive Expiratory Pressure (OPEP) that can be prescribed to help with mucus clearance. These can be devices that you breathe into that produce vibrations to loosen mucus.

• Seeing a physiotherapist or respiratory therapist for regular chest physiotherapy can also help loosen and manage excess mucus.

• Using a humidified high flow therapy device can also help relieve this symptom.

• Last, avoiding triggers that promote mucus production and airway irritation is key.

Shortness of Breath (Dyspnea)

This symptom often starts small and becomes increasingly worse over time. At first, a person with COPD may experience occasional shortness of breath, especially after moderate exercise.

Eventually, they may experience shortness of breath after milder forms of exercise and general day-to-day activities. It can often sneak up on people, and they believe their shortness of breath is just a result of getting older.

 

Shortness of breath can be caused by mucus creating an obstruction in the air passages (bronchi) of the lungs. A person with COPD may also have shortness of breath because the tiny air sacs in the lungs (alveoli) have been damaged and cannot get rid of carbon dioxide properly. This symptom can have a serious effect on a person’s overall quality of life.

What you can do about it:

 

• There are medications available to slow the progression of COPD symptoms like shortness of breath. Puffers can be used to open up (dilate) the bronchi, making it easier to breathe.

• Mucus clearance devices and therapies such as Oscillating Positive Expiratory Pressure (OPEP), and Humidified High Flow Therapy (e.g., myAIRVO) can also help.

• Home oxygen therapy can help improve your shortness of breath if you have hypoxemia (low oxygen in your blood).

• NIV therapy can improve your dyspnea as it splints open your airways allowing air to exchange and chasing the carbon dioxide that could get trapped in your lungs.

• Proper breathing techniques like pursed-lip breathing, diaphragmatic breathing, and prolonging the exhalation phase can help reduce feelings of shortness of breath.

• Additionally, it’s important to exercise regularly and quit or reduce smoking to prevent shortness of breath and manage other COPD symptoms.

• Shortness of breath can lead to additional symptoms of anxiety and depression, so reaching out for support for your mental health is key.

Chest tightness

Some people with COPD experience a tight feeling in the chest that may make it difficult or painful to breathe. Chest tightness can be caused by inflammation in the airways, air sac damage, or a respiratory infection.

What you can do about it:

 

• Treatment of this symptom can include bronchodilators, which can be used to open the airways of the lungs.

• Avoiding irritants like smoke or pollution is also important to manage chest tightness.

• Using breathing techniques and staying as active as possible are other effective ways to prevent and manage this symptom.

Wheezing

Wheezing is a high-pitched whistling sound that happens when a person breathes in or out. It is usually caused by some kind of blockage or narrowing of the airways of the lungs. This blockage or narrowing often comes from mucus and inflammation that tightens the bronchi and causes air to make a wheezing noise when it goes through the airways.

What you can do about it:

 

• Wheezing is a sign that you need to use your puffers.

Bronchodilator inhalers can be used to address wheezing. They relax the muscles around the airways, allowing air to flow through them more easily.

• Avoiding triggers like air pollution and cigarette smoke is also essential to limit wheezing.

Frequent respiratory infections

People with COPD are often not able to clear mucus out of their lungs properly, which causes pathogens (like bacteria and viruses) to get trapped in their lungs. These pathogens can easily start lung infections like pneumonia or COPD exacerbations.

What you can do about it:

 

• Working to maintain overall health and wellbeing is essential to prevent respiratory infections.

• If you have COPD, make sure you stay up-to-date with vaccines and avoid smoking and second-hand smoke.

• Be careful to avoid being around other people with colds or the flu. If you must be around someone who is sick, it’s important to maintain a safe physical distance and wash your hands frequently.

• Make sure you contact your health care provider or check your COPD action plan at the first sign of worsening of your symptoms. It could be a sign of an infection and, with your doctor’s advice, you might need to start treatment with antibiotics and/or steroid medications.

Treatment Options

When a person is diagnosed with COPD, they should set up a COPD action plan with their doctor. COPD action plans detail what to do in case of worsening or severe symptoms. They show what steps to follow to increase inhaler dosages, which prescription medications to take (if applicable), who to contact if feeling worse, and when to visit the hospital.

 

Not all people will have a COPD action plan, but most are eligible for one. Talk to your doctor today to set one up. COPD action plans are so important because time is of the essence during an exacerbation and the fastest treatments are at-home ones.

 

The treatment of a COPD exacerbation depends on its cause and severity.

If an exacerbation is caught early, treatment may include:

Inhalers

Also known as puffers, they deliver medication straight into your lungs. As you press down on the mechanism, you take a deep breath in and hold the breath for the medication to reach the lungs.

Corticosteroid pills

This is a type of anti-inflammatory medication. It reduce inflammation, making it easier for air to travel through the lungs.

Antibiotic pills

Antibiotics are medicines that fight bacterial infections. They work by killing the bacteria or by making it hard for the bacteria to grow and multiply.

Secretion clearance techniques

These techniques such as coughing and huffing, chest physiotherapy, etc. are essential to removing excess mucus so that you can breather easier.

These treatments open up the airways, lower inflammation, kill bacteria, and help remove mucus plugs, respectively. When these are used early, many people can stay home and recover to their baseline within a few days or weeks.

If an exacerbation becomes more severe, more treatment is required. Depending on the severity of the exacerbation, hospitalization may be necessary and treatment may include:

Nebulized inhaled bronchodilators

A nebulizer changes medication from a liquid to a mist so you can inhale it into your lungs. It helps get the medication deep into the lungs where it’s needed most.

IV Antibiotics and/or Corticosteroid

Similar to it’s pill version for it’s effects. But the intravenous route is known to be the fastest way to deliver drugs.

Oxygen Therapy

It’s required when people’s oxygen saturation (the amount of oxygen in the blood) becomes too low. It “tops up” blood oxygen levels to prevent the life-threatening effects of low oxygen.

Humidified High Flow Therapy

It delivers high flow of air/oxygen that is heated and humidified. This therapy helps with symptoms such as mucus secretions, persistent cough and breathlessness.

And in the case of acute respiratory failure, where you are likely hospitalized:

  • Noninvasive positive pressure ventilation / BiPAP (the person remains awake and a machine helps them breathe with a mask)
  • Intubation and mechanical ventilation (the person is sedated and a machine helps them breathe with a tube placed down the throat and into the airways)
  • Intensive Care Unit (ICU) stay

To get control of a severe exacerbation, doctors need to stabilize a person’s oxygen levels, reduce lung inflammation, and eradicate infections. The person may also need additional treatment to support their heart, blood pressure, or other organs. This usually requires many different treatments and possibly several days in the ICU.

 

Recovery from a severe COPD exacerbation may take days to weeks to even months. Once recovered from a COPD exacerbation, people should meet with their health care team to determine whether there is anything they can do to prevent the next episode. Some people with severe COPD may be referred to a respirologist (lung specialist) and may receive prescriptions for daily antibiotics. An exacerbation often leads to a referral to pulmonary rehab. Others with severe COPD may even be referred for surgery to help remove damaged portions of the lungs.

FAQ

Frequently Asked Questions

Prevention in this disease is key. The best way to prevent an exacerbation is by using your inhalers properly and regularly and knowing your symptoms.

If you smoke, seek help to stop or cut back. Make sure you are up to date with routine immunizations. Take note of what triggers your flare-ups. Check in regularly with your medical team and attend regular medical follow-ups.

Ask your doctor about possible supplements or vitamins, since a 2019 study showed that Vitamin D supplementation for severely deficient or hospitalized COPD patients can reduce number of future episodes and hospital admissions.

Consider attending lung health classes or pulmonary rehabilitation if available in your area. Try to eat nutritious meals and participate in movement or exercise that is appropriate for you.

Although you may still experience flare-ups, these steps will help you recognize and take control of them quickly.

If caught and treated early, most exacerbations can be treated at home. However, one exacerbation tends to lead to another, and another, and so on. Each one affects lung function and your ability to breathe.

Too many exacerbations can even push you into the next stage of COPD.

In this Canadian research paper, Dr. Samy Suissa studied the files of 73,106 Quebec patients who were hospitalized with COPD between 1990 and 2007.

The results show, on average, that patients who have a first exacerbation do not have another for five years. But, the average time between the ninth and tenth exacerbation is less than four months. The more exacerbations someone experiences, the sooner the next one may occur.

Also, after the second severe exacerbation, patients were three times more likely to have a third exacerbation. By the time they had their tenth exacerbation, they were twenty-four times more likely to have another severe exacerbation.

The complications can be severe if you don’t seek immediate treatment when experiencing a COPD exacerbation.

These complications can include sepsis, which is a life-threatening medical emergency that happens when the blood becomes infected and the person’s body has an extreme response to that infection.

Other possible complications include pulmonary fibrosis, which is scarring of the lungs, or even acute respiratory failure—which is fatal if not given appropriate treatment.

Acute respiratory failure is a complicated process that occurs when the lungs can’t transfer oxygen into the blood and/or take carbon dioxide out. In turn, the organs can’t get enough oxygen-rich blood to function.

Part of the underlying reason for this is that the lung passages are extremely inflamed and the air sacs have lost their elasticity and are distended. Additionally, the lung muscles become severely fatigued during a COPD exacerbation.

When patients are experiencing acute respiratory failure, they start to have very rapid shallow breathing and other symptoms from not having enough oxygen in their bodies. If not treated quickly with oxygen and breathing machines (mechanical ventilation), acute respiratory failure is fatal.

Make sure you discuss with your family members or substitute decision-makers about your wishes for treatment, in case you are ever unable to speak for yourself.

The average length of stay in hospital for a patient having a COPD exacerbation is seven days. Sometimes, this includes some time in the intensive care unit (ICU).

Hospital stays can usually be avoided by getting medical help as soon as you notice new symptoms.