- 9 Early Warning Signs And Symptoms
- Early warning signs & symptoms of COPD
- Every person with COPD has unique symptoms
- Know the Warning Signs of COPD
- 7 Signs Your COPD Is Getting Worse
- Managing Symptoms, Exacerbations, and Progression
- 1. Increased Shortness of Breath
- 2. Wheezing
- 3. Changes in Phlegm
- 4. Worsening Cough
- 5. Fatigue and Muscle Weakness
- 6. Edema
- 7. Feeling Groggy When You Wake Up
- Chronic Obstructive Pulmonary Disease (COPD)
9 Early Warning Signs And Symptoms
A neat thing about having COPD is it communicates with you. It lets you know when something is wrong, or when a flare-up is impending. It communicates by presenting you with early warning signs and symptoms.
Early warning signs & symptoms of COPD
A sign is something you or anyone around you can observe. A symptom is something only you can feel. Here are 9 early warning signs & symptoms of COPD.
1. Increased shortness of breath
A classic early warning symptom is feeling short of breath. Or, it’s feeling more short of breath than what is normal for you.
2. Coughing more than usual
You may cough some on a regular basis every day. Coughing more than this usual amount is a classic early warning sign.
3. Chest tightness
So, your chest feels sore. Or, you feel chest tightness. Of course, this may occur because of sore chest muscles due to coughing. It may also be due to changes occurring inside your chest.
4. Feeling anxious
And I suppose I ought to add “feeling more anxious than what is normal for you.” By anxious, I’m referring to constant worrying. You may be thinking things like, “Am I really short of breath, or do I just think I am.” Or, “Should I seek help? Or can I handle it on my own.” “Should I call my doctor?” “Oh, I don’t know what to do?” If you’re thinking these or similar thoughts, chances are it’s time to seek help.
5. Fluid retention
Retaining fluid is another sign worth noting. It’s a sign that changes are occurring inside your body that might cause a flare-up. You can observe it by noting a sudden weight gain. It can also be observed by new or worsening feet or ankle edema.
6. Trouble sleeping
There are many reasons why people with COPD may start to have trouble sleeping. This could be due to changes inside your chest, causing you to feel short of breath while lying down. This could be due to declining oxygen levels. It could be due to coughing or anxiety. It could also be due to side effects to all the medicine you are taking.
7. Feeling cold symptoms
Respiratory viruses are very common COPD triggers. They could be the cause of changes occurring inside your chest. Colds usually start out mild and progress over time. They can cause flare-ups. They can even cause severe flare-ups. Healthy people can tough colds out. People with COPD might be best served to heed the sniffling and sneezing as early warning signs. And to heed the scratchy throat and itchy nose as early warning symptoms.
8. Sputum changes colors
The normal color of sputum is clear. Asthmatics tend to have white sputum. For many people with COPD it’s yellow. When you cough it up, you should pay attention to your sputum color, even on good COPD days. You should know what’s normal for you. This way, when it changes colors, you’ll know that something has changed. Brown, green, and red are definitely abnormal. So, changes to your sputum color can definitely be an early sign that something is wrong.
9. Feeling you need rescue medicine more than usual
Many people with COPD have prescriptions for rescue medicine, like albuterol. If you’re using this medicine more than normal, this is a classic early warning sign.
Every person with COPD has unique symptoms
Each person experiences early warning signs and symptoms that are unique. Does your chin itch? Do you get a headache? Do you experience allergy symptoms? What signs and symptoms are unique to you?
You can work with your doctor to learn your early warning signs and symptoms. When observed, actions you take right now can prevent an impending flare-up. Your doctor can also help you create an Action Plan for helping you decide what actions to take, such as when to seek help.
Know the Warning Signs of COPD
Katarzyna LaLicata, MSN, FNP-C, FNP-BC Thursday February 14, 2019 In the beginning stages of chronic obstructive pulmonary disease (COPD), patients may have no symptoms or mild ones. However, as the disease progresses, symptoms may include chest tightness, a cough with mucus production, a low fever, shortness of breath, and wheezing.1 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) no longer emphasizes distinguishing chronic bronchitis from emphysema, the 2 main types of COPD. It instead focuses on the airflow-limited state.2
COPD is a disease whose hallmark features include persistent respiratory symptoms accompanied by airflow limitation that is secondary to airway and/or alveolar abnormalities, often caused by significant exposure to noxious gases or particles.3
Chronic bronchitis is defined as the presence of cough and sputum production for at least 3 months a year in each of 2 consecutive years, according to GOLD’s 2019 report.3
Histologically, chronic bronchitis is characterized by mucous gland hyperplasia, with a relatively undamaged pulmonary capillary bed, unlike emphysema.4 Pathologically, emphysema is characterized by abnormal enlargement of air spaces distal to the terminal bronchiole, with permanent destruction of their walls without obvious fibrosis.5
Patients with chronic bronchitis and emphysema may be differentiated by their presentation, including associated cardiac findings, lung assessment findings, sitting position in the office, type of cough, and weight. Those with chronic bronchitis may be obese and experience frequent coughing with expectorant, coarse rhonchi and wheezing on lung exam, and edema and cyanosis that can be associated with right-sided heart failure. They also may be thin and have barrel chests. Hyper-resonant lung sounds and wheezing may be heard, or they may have pursed lip-breathing accompanied by a tripod position and use of accessory muscles and little or no cough or expectorant reported.4 On chest radiography, findings include increased broncho vascular markings and cardiomegaly. Emphysema shows increased anteroposterior diameters and retrosternal airspace, flattened diaphragms, and hyperinflation.6
COPD diagnosis is made with spirometry, when the ratio of forced expiratory volume in 1 second is less than 70% of a match control, signifies an obstructive defect. A high-resolution computed tomography can help diagnose emphysema, given that it has better sensitivity then a chest radiograph.
The 6 minute walk test is part of the BODE index to predict mortality for patients with COPD. Other tests used for the work-up of COPD to aid in diagnosis or determine worsening progression include alpha-1 antitrypsin, arterial blood gases, b-type natriuretic peptide and N-terminal pro b-type natriuretic peptide, electrocardiography, serum chemistries and hematocrit, right-sided heart catheterization, sputum evaluation, and 2 dimensional echocardiogram.4 Differential diagnosis of COPD can include asthma, bronchiectasis, congestive heart failure, diffuse pan bronchiolitis, and obliterative borchiolitis.3
The key to managing COPD is a thorough assessment that includes spirometry testing, the nature and magnitude of the symptoms, history of moderate and severe exacerbations and future risk, and presence of comorbidities, such as diabetes, gastroesophageal reflux disease, heart failure, and osteoporosis. The GOLD (2019) refined ABCD assessment tool can be used to guide treatment.3 Treatment goals include improving exercise tolerance and health status, preventing disease progression, preventing and treating exacerbations, reducing mortality, and relieving symptoms. Smoking cessation is key to managing chronic bronchitis and COPD.3
COPD exacerbation can be managed in the outpatient setting, but it is important to determine if it is life-threatening and indicates hospitalization.3 Treatment includes medications, such as inhaled or oral corticosteroids, short- and long-acting β2-agonist bronchodilators, phosphodiesterase 3 inhibitors, respiratory anticholinergics, and a combination medication of β2 agonists and corticosteroids or anticholinergic inhalations. Treatment may also include an improved diet, infection control, management of sputum viscosity and clearance, oxygen therapy, pulmonary rehab, smoking cessation, vaccinations, and alpha-1 antitrypsin deficiency treatment to aid the patient’s functional status and quality of life.4 Short-term use of codeine or dextromethorphan can also help with management of a cough associated with chronic bronchitis.7
Chronic bronchitis is the beginning point of the progression of COPD. As of 2017, research was focusing on the actual mucus itself, especially the concentration of mucin, which is abnormally high in patients with chronic bronchitis. The University of North Carolina School of Medicine in Chapel Hill is working to analyze mucin concentration and phlegm samples.8 Pulmonologists at the University of Iowa Hospital & Clinics in Iowa City also are working on clinical trials for patients with chronic bronchitis by attempting to kill cells that produce mucus with low-level energy.9
The FDA recently approved the first and only digital inhaler with a built-in sensor that can monitor the usage and strength of a user’s inhalation. The ProAir Digihaler is approved for patients 4 years and older and will be available in 2019, with a national launch in 2020.10 Clinical studies are also under way for the angiotensin II receptor blocker losartan in the management of chronic bronchitis and COPD.11 Families can also test for alpha-1 deficiency if there is a family history of COPD or liver disease.12
Chronic bronchitis and emphysema are progressive lung diseases under the umbrella term of COPD. Improving care for patients is important to help prevent and treat COPD exacerbations and prevent COPD-related admissions and readmissions. The GOLD (2019) report can aid providers in determining the best individualized treatment plans. To allow for a quick diagnosis and early intervention, counsel patients to alert their providers if they have a cough lasting at least 3 months a year for 2 consecutive years. ®
Katarzyna LaLicata, MSN, FNP-C, FNP-BC, is a nurse practitioner at CVS Minute Clinic and an associate clinical assistant professor at National University in San Diego, California.
- US National Library of Medicine. Chronic bronchitis. MedlinePlus website. medlineplus.gov/chronicbronchitis.html. Accessed December 28, 2018.
- Boka K, Ouellette DR. Emphysema. Medscape website. emedicine.medscape.com/ article/298283-print. Updated August 21, 2016. Accessed December 28, 2018.
- Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2019 Report. GOLD COPD website. goldcopd.org/wp-content/uploads/2018/11/ GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf. Accessed December 28, 2018
- Mosenifar Z, Harrington A, Nikhanj NS, Kamangar N. Chronic obstructive pulmonary disease (COPD). Medscape website. emedicine.medscape.com/article/297664-print. Updated November 15, 2018. Accessed December 28, 2018
- Chestnutt MS, Prendergast TJ, Tavan ET. Pulmonary disorders. In: Papadakis MA, McPhee SJ, Rabow SW, eds. Current Medical Diagnosis & Treatment. 53rd ed. New York, NY: McGraw Hill; 2014:250-251.
- Kleinschmidt P. Chronic obstructive pulmonary disease (COPD) and emphysema in emergency medicine. Medscape website. emedicine.medscape.com/article/807143-print. Updated and published October 25, 2018. Accessed January 16, 2019.
- Clinical Resource, Treatment of Cough in Adults. Pharmacist’s Letter/Prescriber’s Letter. January 2018. prescriber.therapeuticresearch.com/Content/Segments/ PRL/2015/Feb/Treatment-of-Cough-in-Adults-8095.
- University of North Carolina Health Care. Chronic bronchitis: new insights could lead to first diagnostic test, better treatments. ScienceDaily website. sciencedaily. com/releases/2017/09/170906221217.htm. Published September 6, 2017. Accessed December 28, 2018
- McCarver KA. UIHC seeks a cure for chronic bronchitis. The Daily Iowan. November 29, 2018. dailyiowan.com/2018/11/29/uihc-seeks-a-cure-for-chronic-bronchitis. Accessed December 28, 2018
- Brooks M. FDA approves first digital inhaler with tracking app. Medscape website. medscape.com/viewarticle/906940_print. Published December 24, 2018. Accessed December 28, 2018.
- Effect of Losartan on Airway Mucociliary Dysfunction in Patients With COPD and Chronic Bronchitis. clinicaltrials.gov/ct2/show/NCT02416102. Updated February 7, 2018. Accessed December 28, 2018
- Howley EK. Does COPD have a genetic component? US News and World Report. June 2, 2017. health.usnews.com/health-care/patient-advice/articles/2017-06-02/doescopd-have-a-genetic-component. Accessed December 28, 2018.
7 Signs Your COPD Is Getting Worse
Shortness of breath and wheezing are signs that your COPD may be getting worse. iStock
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Frequent coughing or wheezing, excess mucus and shortness of breath are hallmark symptoms of chronic obstructive pulmonary disease (COPD), the third leading cause of death in the United States. A person’s particular symptoms and their severity can be signs that the condition is worsening.
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.
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.
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.
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Karen Selby, RN
Registered Nurse and Patient Advocate
Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the regional director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.
Edited by Walter Pacheco Medical Review By Dr. Sanjay R. Jain
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