The hallmark symptom of COPD is shortness of breath that gets worse over time. It is often accompanied by a phlegm-producing cough and episodes of wheezing. Symptoms may vary, however, or others may be present, depending on the disease involved. Many patients have symptoms of both chronic bronchitis and emphysema.
Symptoms of Emphysema
Typically, the first symptoms of emphysema occur in heavy smokers in their mid-50s:
- The main early symptom is shortness of breath with light physical activity. Coughing is usually minor, and coughs produce little sputum (phlegm).
- Late, severe symptoms include rapid, labored breathing and persistent craving for air (air hunger), even during rest or after minimal physical activity.
- Patients are often very thin (a wasted look called "cachexia"), have pinkish skin, and tend to breathe through pursed lips.
- Involuntary weight loss and muscle wasting may occur, and can indicate a poor outlook.
Symptoms of alpha-1 antitrypsin-related emphysema tend to appear between the ages of 30 and 40. Similar to the symptoms of emphysema, they include:
- Inability to exercise without becoming winded
- Shortness of breath after physical activity
Symptoms of Chronic Bronchitis
Chronic bronchitis usually causes the following symptoms:
- Coughing with excessive phlegm occurs on most days for at least 3 months of the year, during 2 consecutive years. Coughing often starts before shortness of breath.
- Shortness of breath occurs, but it may not be as severe during rest as it is in people with emphysema.
- Lying down at night worsens symptoms in chronic bronchitis with heart failure, so patients sleep propped up.
- In late, severe stages, lack of oxygen causes the skin to have a blue color (cyanosis).
- The body may swell from fluid build-up caused by heart failure.
Chronic cough is the hallmark symptom of chronic bronchitis starting in its early stages.
Review Date: 04/10/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.