Quick GuideCOPD Lung Symptoms, Diagnosis, Treatment

Chronic obstructive pulmonary disease is a slowly progressive disease so it is not unusual for the initial signs and symptoms to be a bit different from those in the late stages of the disease. There are many ways to evaluate or stage chronic obstructive pulmonary disease, often based on symptoms.

Usually the first signs and symptoms of COPD include a productive cough usually in the morning, with colorless or white mucus (sputum).

The most significant symptom of chronic obstructive pulmonary disease is breathlessness, termed shortness of breath (dyspnea). Early on, this symptom may occur occasionally with exertion, and eventually may progress to breathlessness while doing a simple task such as standing up, or walking to the bathroom. Some people may develop wheezing (a whistling or hissing sound while breathing). Signs and symptoms of chronic obstructive pulmonary disease include:

• Cough, with usually colorless sputum in small amounts
• Acute chest discomfort
• Shortness of breath (usually occurs in patients aged 60 and over)
• Wheezing (especially during exertion)

As the disease progresses from mild to moderate, symptoms often increase in severity:

• Respiratory distress with simple activities like walking up a few stairs
• Rapid breathing (tachypnea)
• Bluish discoloration of the skin (cyanosis)
• Use of accessory respiratory muscles
• Swelling of extremities (peripheral edema)
• Over-inflated lungs (hyperinflation)
• Wheezing with minimal exertion
• Course crackles (lung sounds usually with inspiration)
• Prolonged exhalations (expiration)
• Diffuse breath sounds
• Elevated jugular venous pulse

The primary cause of chronic obstructive pulmonary disease is cigarette smoking or exposure to tobacco smoke. It is estimated that 90% of the risk for development of chronic obstructive pulmonary disease is related to tobacco smoke. The smoke also can be secondhand smoke (tobacco smoke exhaled by a smoker and then breathed in by a non-smoker).

Other causes of chronic obstructive pulmonary disease are:

• Prolonged exposure to air pollution, such as that seen with burning coal or wood and with industrial air pollutants
• Infectious diseases: Infectious diseases that destroy lung tissue in patients with hyperactive airways or asthma also may contribute to causing this COPD.

Damage to the lung tissue over time causes physical changes in the tissues of the lungs and clogging of the airways with thick mucus. The tissue damage in the lungs leads to poor compliance (the elasticity, or ability of the lung tissue to expand). The decrease in elasticity of the lungs means that oxygen in the air cannot get by obstructions (for example, thick mucus plugs) to reach air spaces (alveoli) where oxygen and carbon dioxide exchange occurs in the lung. Consequently, the person exhibits a progressive difficulty, first coughing to remove obstructions like mucus, and then in breathing, especially with exertion.

People who smoke tobacco are at the highest risk for developing chronic obstructive pulmonary disease. Other risk factors include exposure to secondhand smoke from tobacco and exposure to high levels of air pollution, especially air pollution associated with wood or coal. In addition, individuals with airway hyper-responsiveness such as those with chronic asthma are at increased risk.

There is a genetic factor called alpha-1 antitrypsin deficiency that places a small percentage (less than 1%) of people at higher risk for COPD (and emphysema) because a protective factor (alpha-1 antitrypsin protein) for lung tissue elasticity is decreased or absent.

Other factors that may increase the risk for developing chronic obstructive pulmonary disease include

• intravenous drug use,
• immune deficiency syndromes,
• vasculitis syndrome,
• connective tissue disorders, and
• genetic problems such as Salla disease (autosomal recessive disorder of sialic acid storage in the body).

One way to stage chronic obstructive pulmonary disease is the Global Initiative for Chronic Obstructive Lung Disease program (GOLD). The staging is based on the results of a pulmonary function test. Specifically, the forced expiratory volume (how much air one can exhale forcibly) in one second (FEV1) of a standard predicted value is measured, based on the individual patient's physical parameters. The staging of chronic obstructive pulmonary disease by this method is as follows:

• Stage I is FEV1 of equal or more than 80% of the predicted value
• Stage II is FEV1 of 50% to 79% of the predicted value
• Stage III is FEV1 of 30% to 49% of the predicted value
• Stage IV is FEV1 of less than 30% of predicted value or an FEV1 less than 50% of predicted value plus respiratory failure

Other staging methods are similar but are based on the severity of the shortness of breath symptom that is sometimes subjective. The above staging is measurable objectively, providing the patient is putting forth their best effort.

In general, three other non-genetic problems related to the lung tissue play a role in chronic obstructive pulmonary disease. 1) chronic bronchitis, 2) emphysema, and 3) infectious diseases of the lung.

• Chronic bronchitis and emphysema, are thought by many to be variations of chronic obstructive pulmonary disease and considered part of the progression of chronic obstructive pulmonary disease by many researchers. Chronic bronchitis is defined as a chronic cough that produces sputum for three or more months during two consecutive years.
• Emphysema is an abnormal and permanent enlargement of the air spaces (alveoli) located at the end of the terminal bronchioles in the lungs.
• Infectious diseases of the lung may damage areas of the lung tissue and contribute to chronic obstructive pulmonary disease.

The preliminary diagnosis of COPD is diagnosed in a person with chronic obstructive pulmonary disease symptoms by

• his/her breathing history,
• the history of tobacco smoking or exposure to secondhand smoke, and/or
• exposure to air pollutants, and/or a history of lung disease (for example, pneumonia).

Other tests to diagnose COPD include:

• Chest X-rays
• CT scan of the lungs
• Arterial blood gas or a pulse oximeter to look at the saturation level of oxygen in the patient's blood

In addition, the person may be sent to a lung specialist (pulmonologist) to determine their FEV1 level that is used by some physicians to stage COPD as described above in the section that describes the stages of COPD.