According to the Centers for Disease Control and Prevention (CDC), almost 16 million people in America have COPD, a classification that includes emphysema and chronic bronchitis. COPD can be early, moderate, severe, or very severe depending on your symptoms, the number of exacerbations you’ve had, and your lung function. In early COPD, a person may have chronic cough and phlegm but may not be aware they have reduced lung function; they sometimes dismiss their symptoms as a normal part of aging. Symptoms are impossible to ignore in severe COPD. A person with severe COPD can get short of breath even while walking slowly or getting out of a chair.
Managing Symptoms, Exacerbations, and Progression
Even though there is no cure for COPD, there are treatments to improve symptoms. If you take steps to quit smoking, to exercise, and to improve your diet, you can increase your life expectancy and have a better quality of life. Avoiding exacerbations, which is when symptoms flare up or get worse, is a major part of slowing the progression of COPD, says Meredith McCormack, MD, an associate professor of medicine at Johns Hopkins Medicine in Baltimore. Exacerbations can happen fast, within a matter of hours or days, according to the American Thoracic Society (ATS). RELATED: What Your Loved Ones Need to Know About COPD “Exacerbations are often triggered by respiratory infections which could be viral or bacterial,” says Dr. McCormack. “They can also be triggered by exposures, like if someone has an increased exposure to pollution or secondhand smoke,” she says. In a review published in October 2017 in the International Journal of Chronic Obstructive Pulmonary Disease, the authors noted that severe exacerbations are associated with higher mortality, and the risk increases with each new exacerbation. “COPD exacerbations is one of the most important predictors of the progression of COPD, and a history of exacerbations is one of the most important predictors of future exacerbations,” says McCormack. That’s part of why it’s so important to take steps to try to minimize the risk of exacerbations, she adds. The following are signs that may indicate that a person’s COPD is getting worse.
1. Increased Shortness of Breath
“Worsening shortness of breath is a cardinal signal that your COPD is getting more severe,” says Robert A. Wise, MD, the director of research in pulmonary and critical care medicine at Johns Hopkins Medicine in Baltimore. If climbing the stairs or walking up a slight incline has become harder for you, that could indicate your condition is deteriorating, says Dr. Wise. If the increase in shortness of breath is relatively mild, your symptoms could be managed by your doctor by increasing medication or adding medications, says McCormack. “In more severe cases it might require an emergency room visit or hospitalization,” she says.
2. Wheezing
The narrowing of the airway can cause wheezing, a high-pitched whistling sound that happens as you breathe. If your wheezing gets worse, it could be a sign of an exacerbation. Wheezing that becomes much more pronounced very quickly or stays constant (doesn’t come and go) should get medical attention right away, according to the Merck Manual. Not everyone who has COPD has wheezing. In a study from October 2015 in the International Journal of Chronic Obstructive Pulmonary Disease, researchers found that about 38 percent of people with COPD had wheezing as a symptom. In the study group, wheezing was associated with worse COPD symptoms, more exacerbations, and worse lung function.
3. Changes in Phlegm
Exacerbations could cause an increase in the amount of phlegm you produce, and the color of the phlegm might change from clear to yellow or green, says McCormack. According to the ATS, a change in phlegm (also called mucus or sputum) is often one of the first signs that your COPD is getting worse. The color change may signal an infection in the lungs.
4. Worsening Cough
“If you develop a worsening cough or a new onset of cough and it’s persisted for several weeks, you should be checked by your doctor,” says Wise. A chest X-ray may be necessary. The X-ray images could indicate if there are physical signs that your COPD is getting worse or if the increased cough or chest pain could be due to another health issue, such as a problem with your heart.
5. Fatigue and Muscle Weakness
A lot of patients with COPD are tired all the time, says Amy Attaway, MD, a pulmonologist at the Cleveland Clinic in Ohio. This isn’t surprising considering that the condition by itself can cause a lot of fatigue, she says. “It really comes down to the fact that your body has to work harder than someone’s who doesn’t have COPD. More of your energy is spent simply breathing,” says Dr. Attaway. “Fatigue in COPD can also be caused by inflammation that leaks out to the rest of your body,” she says. “You can actually get muscle weakness from that,” she says.
6. Edema
In more severe COPD, edema can cause the ankles, legs, and feet to swell. The fluid retention can cause a weight gain of anywhere from 5 to 15 pounds, says Wise. This swelling is due to what is known as cor pulmonale, or pulmonary hypertension. Those conditions are caused by a combination of not enough oxygen, inflammation, and high pressure on the lung vessels and right side of the heart that can happen as a result of emphysema. A 2009 study published in the journal Chest suggests that pulmonary hypertension is associated with a decrease in life expectancy.
7. Feeling Groggy When You Wake Up
“Sometimes as COPD advances people start to have low oxygen at night,” says Attaway. “The way it manifests is that they just feel really tired or groggy when they first get up.” This lack of oxygen can be a result of severe COPD, but it could also be a sign of obstructive sleep apnea, according to the American Thoracic Society. “Sleep apnea or sleep disordered breathing is a frequent comorbidity with COPD and should be treated to help avoid exacerbations,” says McCormack.
