The symptoms of COPD are mild at first but become more severe and debilitating as the disease progresses.

Normal Lung and Emphysemic Lung

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Early Symptoms of COPD

Morning Cough

Daily morning 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.

Shortness of Breath

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.

Symptoms of More Advanced COPD

Severe Shortness of Breath and Chronic, Persistent, Productive Cough

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.

Fatigue and Mental Changes

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.

Heart Problems

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.

Fluid Accumulation

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.

Increased Chest Size

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.”

Increased Risk of Serious Lung Infections

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.