Symptoms & Risk Factors for COPD

Daily cough, which is usually first noticed in the winter months, with clear sputum (mucus from the lungs) is the earliest symptom of COPD. Coughing may be worse during a cold or respiratory infection, and the mucus may turn yellow or green.

A whistling or rustling sound may be heard when exhaling, which is prolonged. Wheezing often worsens with a cold or respiratory infection.

This symptom develops as COPD becomes progressively worse. At first, shortness of breath may only occur with physical exertion, but as the disease becomes more advanced, it may occur after very modest activity. When the illness becomes very severe, shortness of breath occurs even at rest.

Even very mild activities produce significant shortness of breath. Repeated bouts of coughing with sputum production may become disabling. Nighttime coughing may interfere with sleep and you may feel a choking sensation when lying flat. Difficulty breathing may cause sufferers to breathe through pursed lips or to lean forward when sitting or standing in order to breathe more comfortably.

Repeated bouts of coughing and poor oxygen exchange within the lungs leads to fatigue, headache, and mental changes, such as irritability, anxiety, or difficulty sleeping and concentrating.

COPD makes the heart work harder, especially the right side of the heart, which pumps blood to the lungs. The walls of the heart become thickened from the extra work needed to pump blood into the resistant lungs. The normal rhythm of the heart may also be disturbed. Lack of oxygen in your blood can produce a bluish tinge to your skin, nails, and lips, called cyanosis.

The extra strain on the right side of the heart may cause a slowdown of blood circulation. This, in turn, can cause engorgement of the large veins and liver, and eventually fluid leakage into the abdomen, legs, and ankles (edema). This right-sided heart failure is called cor pulmonale.

Because COPD destroys the normal lung structure, you cannot exhale completely. Air is trapped in the lungs, which become hyperinflated, causing the chest to expand, leading to a permanent condition referred to as “barrel chest.”

The accumulation of mucus and fluid in the lungs provides an ideal environment for bacteria and viruses to grow. These lung infections may become quite serious, further compromising breathing ability.

The most important risk factor for COPD is cigarette smoking. Between 80 percent and 90 percent of COPD cases are caused by cigarette smoking. Although most cases of COPD are related to smoking, not all smokers develop COPD. This suggests that other factors in your environment or genetic make-up also contribute to the development of COPD. New research also suggests that people who are chronically exposed to second-hand smoke have an increased risk of developing COPD.

Although COPD usually develops in older persons with a long history of cigarette smoking, one form of emphysema has a genetic component and is more common in persons of northern European descent. Persons with this form of COPD have a hereditary deficiency of a blood component, known as alpha-1-protease inhibitor (alpha-1-antitrypsin, AAT). About 70,000 Americans are thought to have this genetic deficiency, and it accounts for 1 percent to 3 percent of COPD cases. People with this defect can develop COPD by early middle age. If you have close relatives who developed COPD in their thirties or forties, your risk of this type of COPD may be elevated. A deficiency of AAT can be detected by blood tests available at medical laboratories.

You are more likely to develop COPD as you get older, but this is partly related to the number of years of cigarette smoking.

A history of frequent childhood lung infections increases your risk of developing COPD. Frequent infections can lead to scarring of lung tissues, which reduces their elasticity and can lead to COPD.

COPD is much more common in men than in women, but this may be largely related to the higher rate of smoking among men. As the number of women who have significant smoking histories has increased, the number of COPD-related deaths among women has also risen.

Chronic exposure to dust, ozone, and gases or chemicals, such as traffic exhaust fumes and sulfur dioxide, increase your risk of developing COPD and can worsen symptoms of the disease.