COPD: Symptoms and patient groups

COPD symptoms vary depending on the amount of lung damage that has occurred due to inhaled substances, most commonly smoking. Symptoms are usually slow to develop and often don’t appear until there’s been significant damage. Symptoms can also come and go, and may vary in intensity. An exacerbation is when symptoms get worse. You may need to change your COPD medication in this case. The most important thing you can do if you have COPD is to quit smoking.

Chronic cough

A cough is how the body clears the airways and lungs of mucus and other irritants and secretions. Mucus is usually clear. However, in people with COPD, it may be a yellow color. Often the cough is worst first thing in the morning. You may cough more when you exercise or smoke. The cough may persist every day, even if there are no other symptoms of illness such as a cold or the flu.


When you exhale through narrow or obstructed air passages, you will often hear a whistling or musical sound. This is called wheezing. In people with COPD, it is most often caused by excess mucus blocking the airways. It can also be caused by a tightening of the airways. Wheezing doesn’t necessarily mean you have COPD. It can also be a symptom of asthma or pneumonia.

Shortness of breath (dyspnea)

As the airways in your lungs become inflamed and damaged and begin to constrict, you might find it difficult to breathe or catch your breath. This COPD symptom is most noticeable during increased physical activity. It can make routine daily tasks such as walking, doing simple household chores, dressing, or bathing more difficult. At its worst, it can occur while you are at rest.


If you have difficulty breathing, you often can’t get enough oxygen into your bloodstream and to your muscles. Without the necessary oxygen, your body slows down and fatigue sets in. You may also feel tired because your lungs are working extra hard to get the oxygen in and the carbon dioxide out, thus draining your energy.

Frequent respiratory infections

Because people with COPD have greater difficulty fighting off bacteria and viruses, they can be at greater risk for lung infections such as bronchitis and pneumonia. Though it’s difficult to avoid infections altogether, managing your COPD, quitting smoking, and getting the correct vaccinations can reduce your risk.

Weight loss

If you’ve had COPD for a long time, you may notice that you’ve been losing weight. The extra energy your body requires to breathe and get enough air in and out of the lungs may be burning more calories than your body is taking in, causing you to lose weight. Weight loss may also occur because fatigue and shortness of breath make eating difficult.

Morning headaches can occur due to lower levels of oxygen or higher levels of carbon dioxide in the blood.

Swollen feet and ankles can occur due to increased stress on the heart, which has to work harder to pump blood through the damaged lungs.

People with COPD are divided into four groups, ranging progressively from mild to very severe. Your group is based on the severity of your symptoms, the limitations of your airway and the number of COPD exacerbations you have per year. The severity of your symptoms can be determined by questionnaires given to you by your healthcare provider. The limitations of your airway can be measured by your performance on pulmonary function tests (PFTs). Pulmonary function typically decreases as the grades progress.

Patient group A: Mild COPD

You get short of breath when hurrying across level surfaces or when walking on a slight incline. There’s a cough several days a week but most days are good as far as symptoms go. You have no more than one exacerbation per year of your COPD and you are not hospitalized for it. Results of PFT are usually 80 percent or more of the predicted response, according to the Global Initiative for Chronic Obstructive Lung Disease.

Patient group B: Moderate COPD

You have breathlessness, cough, and sputum on most days and have to adjust your daily routine. You frequently stop to catch your breath. You may also get chest tightness and wheezing as part of your symptoms. You still have no more than one aggravation per year of your COPD and you are not hospitalized. PFT results are 50 to 79 percent of the expected response.

Patient group C: Severe COPD

You have most symptoms of grade B but flares and exacerbations are worse. You have more than one COPD flare per year or you have been hospitalized due to your COPD. Exercise becomes more difficult at this point. Fatigue is increased, and quality of life begins to suffer. Your pulmonary function has also worsened, with results of PFT at 30 to 49 percent of the predicted response.

Patient group D: Very severe COPD

You are breathless all the time and it severely limits everyday activities, such as dressing and undressing. At the most severe stage of COPD, quality of life is significantly reduced because of ongoing shortness of breath. Trouble breathing may even be life-threatening during some episodes. Performance on PFTs are typically less than 30 percent of the expected response. You have frequent exacerbations and hospitalizations due to your COPD.

COPD is a serious condition that affects life in many ways, but it can be managed. Treatment can greatly improve your quality of life. Because it is a progressive disease, signs and symptoms may not be noticeable until the condition has considerably worsened. If you are having trouble breathing or notice an unexplained cough, see your doctor for a medical opinion.