It’s the fourth leading cause of death in the U.S., but unless you or someone you know has chronic obstructive pulmonary disease, or COPD, it’s probably not something you’ve given much thought to. And because its symptoms are common and shared by many conditions, COPD is often misdiagnosed. But catching this disease early makes a big difference in how effectively you can manage it. If you’re concerned you might have COPD, here are some of the things to keep an eye out for.
We went to some of the nation's top experts in COPD to bring you the most up-to-date information possible.
Nereida A. Parada, M.D.Associate Professor of Medicine, Clinical Lead for Asthma and COPD
Paul Andrew Reyfman, M.D.Assistant Professor of Medicine, Pulmonary and Critical Care
Byron Thomashow, M.D. Professor of Medicine, Co-Founder and Senior Medical Advisor
Refresh: What Is COPD Again?
Chronic obstructive pulmonary disease (COPD) is the story of good lungs gone bad. When you have this condition, it feels as though there is something clogging up the airways to your lungs, making it impossible to suck in enough air and leaving you short of breath. There are more than 16.4 million Americans diagnosed with COPD, and the real number of people living with this condition is likely quite a bit higher, since many people don’t seek help until the disease has become severe. The late-stage diagnosis may also contribute to the 150,000 deaths from COPD every year.
To understand COPD, it helps to understand how your lungs work. Check out this quick primer:
Each lung is made up of something called bronchial tubes.
These tubes split into smaller tubes known as bronchioles—kind of like how tree branches fork into smaller branches, which divide into even smaller ones, and so on.
The ends of the bronchioles are covered with alveoli, tiny air sacs that cluster together like grapes on a vine. When you’re healthy, your body has a whopping 480 million alveoli that function like new balloons—pliable and strong.
When you breathe in, your alveoli fill up with air and separate out the oxygen. The oxygen then passes into your bloodstream via your capillaries, where it is transported to muscles and tissues that help you perform your daily functions.
After sending out oxygen, your capillaries then collect and expel carbon dioxide back into the alveoli. This carbon dioxide is released when you exhale, in a process known as gas exchange.
That’s what happens when all is well with your body and your lungs. In COPD, though, your lungs become damaged and the ability of your alveoli to take in air and separate out the oxygen becomes compromised. This can happen in a couple of different ways, as COPD is an umbrella term that incorporates multiple breathing-related conditions.
Two of the most common are emphysema and chronic bronchitis. Let’s review what happen with these disorders.
When the walls of the alveoli break down, the clusters of miniscule air sacs start to blend into one big blob, leaving you with a few larger air sacs. Because the alveoli walls serve as membranes to filter out the oxygen, the fewer sacs you have, the less surface capacity there is for oxygen to reach your bloodstream. And because the airways themselves lose their elasticity with emphysema, airflow can be restricted, causing shortness of breath.
The inflammation and irritation of your lung’s bronchial tubes is known as bronchitis and can lead to coughing fits and shortness of breath. Bronchitis can occur for any number of reasons, but the chronic sort is considered a type of COPD, so it’s important to keep track of how long it lasts for. If you’re coughing and producing mucus at least three months at a time for two years in a row, it’s considered chronic bronchitis. This disease is treatable, but not fully reversible.
What Are the Causes of COPD?
The biggest reason people develop this lung condition is cigarette smoking. When you smoke, you are inhaling more than 4,000 chemicals into your body, at least 40 of which are known to cause cancer. These chemicals irritate and inflame your lungs, signaling to your body to send white blood cells (part of your immune system response) to the area. The white blood cells release enzymes that destroy lung tissue, leading to COPD.
Smoking accounts for about 75% of COPD cases. The remaining 25% of people can attribute it to air pollution like secondhand smoke, ammonia, asbestos, and other chemical fumes. Some asthma sufferers are also diagnosed with COPD, and in this case, treatment can usually reverse the inflammation that causes narrowing in the lung’s airways.
Common Risk Factors for COPD
Given how widespread COPD is, it would stand to reason that the symptoms of it would be fairly obvious. The problem is that there’s no singular indicator for the disease, and the most common signs can easily be mistaken for other respiratory illnesses.
For instance, that cough you’ve had on-and-off since Thanksgiving sounds like a cold you can’t kick. Feeling short of breath, especially when you’re exerting yourself climbing stairs or walking through an airport while pulling your luggage, can seem like a normal part of aging. And if you’re a smoker, you may chalk all the huffing and puffing up to your pack-a-day habit.
So how do you know when to worry? It’s typically when symptoms persist and a sleuthing doctor considers all the possibilities that a diagnosis is whittled down to COPD. Before we get into the specific symptoms, it’s useful to know if you’re at greater risk for developing the disease than other people. Most commonly, people with COPD share at least one of these attributes:
You’re age 40 or older
You currently smoke or have a history of smoking
You are exposed to biomass fuels (particularly related to cooking on an open flame—something that affects around 3 billion people worldwide)
Your occupation exposes you regularly to chemicals or pollution
A relative has been diagnosed with COPD
You’ve been frequently exposed to secondhand smoke
What Are Other Risk Factors for COPD?
Along with these common denominators in people who get COPD, there are a few other things to consider.
Gender: Women are more likely to be diagnosed with COPD than men, but doctors aren’t quite sure why. It could be the result of a push in the 1960s by tobacco companies to entice women to smoke or a difference in their immune system and how it reacts to smoking or pollution. It could also be that women are likelier than men to visit the doctor when symptoms arise.
Genetics: A small percentage of patients have a genetic predisposition to COPD and emerging research from Columbia University Medical Center in New York City suggests that certain people are born with narrower airway passages in their lungs, making them more susceptible to COPD.
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Major Symptoms of COPD
When it comes to spotting the signs of this condition, it helps to focus on the “C” of COPD: chronic. For instance, coughing is considered chronic if it hangs around for two months. Here’s what to look out for when you’re worried about COPD:
Coughing: Wet (producing mucus) or dry coughs are both possible signs of this disease.
Low energy: In some cases, particularly in the early stages of COPD, you may be less aware of breathing trouble, but realize that your energy is sagging (because you’re not getting enough oxygen).
Recurring respiratory infections: Viral infections cause up to 30% of COPD flares, and people with the condition are more prone to them, thanks to their difficulty in clearing their lungs of bacteria, dust, and other pollutants
Shortness of breath: You’ll most likely experience this when you are exerting yourself during exercise or other forceful movement, but it could also happen when you wake up in the middle of the night.
Tightness in the chest: The proverbial elephant-sitting-on-chest comes to mind, as COPD can make it feel like there’s no room in your lungs to suck in the air.
Weight loss: When your body has to work 10 times harder than normal to provide you with enough oxygen to live, you’re burning a ton more calories than the average person. Couple that with the fact that eating itself can leave you short of breath with COPD, and many people with this disease are prime candidates for unintended weight loss as the disease progresses.
Wheezing: A high-itched whistling noise may occur on either your inhale or exhale.
Exacerbations: During these instances, also called flares, you’ll notice one or more of these symptoms get worse for a few days at a time.
Scan this list of symptoms and they seem so ordinary that it’s no wonder COPD gets misdiagnosed. Moreover, it’s not always front-of-mind for general practitioners, because diagnosing COPD takes some sleuthing and often there’s not enough time in a regular doctor’s appointment to pick up on the clues.
That’s a problem in more ways than one: Without knowing the cause of their discomfort, many people with undiagnosed COPD pull back on the activities that trigger shortness of breath—namely, exercise and other forms of physical exertion. This unwittingly leads to more trouble, as less exercise weakens the lungs, which makes them more susceptible to the symptoms of the disease. So by the time COPD patients end up in a pulmonologist’s office, the symptoms have progressed to the point that they are very limited.
There’s also something called the “asthma overlap,” which refers to the fact that a lot of people who have asthma also have a component of COPD—even if they never smoked. All of these variables make getting to the root of your breathing difficulties a challenge. But don’t give up. You and you alone know how much your ability (or lack thereof) to breathe is interfering with your ability to live a full life.
Think about this time last year. Has your overall breathing changed? Your energy level? If you suspect something might be going on, take the COPD Assessment Test, available for free at catesonline.org. If your score is 10 or more, your symptoms are generally considered significant. And even without the self-test, if you have a hunch that your lingering cough is more than seasonal allergies, go get it checked out—and keep asking questions until you feel confident that you’re getting the answers you need.
Frequently Asked QuestionsCOPD Symptoms
Is COPD always caused by smoking?
Not always, but usually. About 75% of diagnosed cases are due to cigarettes. The other 25% are likely caused by exposure to secondhand smoke or other toxic chemicals due to your job or living with a smoker.
Are dry coughs less likely to be caused by COPD?
Actually, COPD coughs can either be dry or wet (meaning there is mucus involved). The most important clue as to whether your cough could indicate COPD is its duration. If it’s lasting two months or more, it’s time to see your doc.
What does weight loss have to do with COPD?
COPD can cause you to unintentionally shed pounds for two reasons. First, when your lungs aren’t working right, it can be 10 times more cumbersome to take a breath. All that extra effort burns a lot of calories. Secondly, when you can’t breathe, the act of eating is uncomfortable, causing a lot of people to cut back on meals. But you need energy to help fight the disease, so talk with your doctor about nutritional supplements if you’re struggling to keep weight on.
It hurts to breathe when I exercise. Should I stop?
Absolutely, 100% no. Working your lungs plays a critical role in keeping them strong, and the stronger they are, the better equipped you will be to fight back against your COPD. It’s not easy, we know. Ask your doctor about pulmonary rehabilitation—a program that sets you up with an exercise routine that is tailored to your level and lung abilities, and will also provide you with breathing exercises so you can work on expanding your lung capacity.
COPD and Viral Infections:International Journal of Chronic Obstructive Pulmonary Disease. (2016). “Treatment of patients with COPD and recurrent exacerbations: the role of infection and inflammation.” ncbi.nlm.nih.gov/pmc/articles/PMC4795571/
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