The hallmark symptom of COPD is worsening shortness of breath, 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 are characteristic of COPD and have a poor outlook.
Symptoms of alpha-1 antitrypsin-related emphysema tend to appear between the ages of 30 and 40. As with standard 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 sputum occurs on most days for at least 3 months of the year, for 2 years in a row. Coughing may often start before shortness of breath.
- Shortness of breath occurs, but it may not be as severe during rest as it is in emphysema.
- Lying down at night worsens symptoms in severe bronchitis, so patients sleep sitting up.
- In late, severe stages, lack of oxygen causes the skin to have a blue cast (cyanosis).
- The body may swell from fluid build-up caused by heart failure.
Chronic cough is the hallmark of chronic bronchitis from its early stages onward.