The main symptoms of COPD (chronic obstructive pulmonary disease) are
- shortness of breath (initially with exercise, in the course of the disease, increasingly, at rest)
- cough (or early morning, most pronounced during exercise, and later at rest)
- sputum (may be mixed with brownish or blood)
The symptoms of COPD can be summarized as shortness of breath, cough and sputum (mucus that is coughed up from the lower airways).
The breathlessness occurs at the beginning of the disease, initially during exercise but later on even while resting.
COPD Symptoms & Diagnosis
What is COPD? Chronic Obstructive Pulmonary Disease is a progressive disease that affects breathing. This classification, COPD, is used to describe two respiratory diseases, Emphysema and Chronic Bronchitis, also called pink puffer and blue bloater (1).
As the chronic obstructive lung disease progresses those affected will often suffer from a reduced physical capacity. Because of the reduced gas exchange, the skin of patients in advanced stages are discolored bluish red.
The main feature is the chronic obstruction of breathing that slowly progresses over years and causes an increase in respiratory distress. COPD (chronic obstructive pulmonary disease) is when both chronic bronchitis and emphysema are present.
A typical first early sign of chronic bronchitis is an early morning cough that also brings up mucus. Unfortunately, this early warning signal (most common in smokers) is often simply accepted as “normal.”
Perhaps the most typical effect of this disease is shortness of breath (dyspnea), that is simply the feeling of not getting enough air. In mild forms of COPD, shortness of breath occurs only while undergoing mild physical exertions, such as climbing stairs. In severe cases, breathing difficulties will happen even at rest and during moderate physical stress.
The practical effects on day to day living imply that managing everyday activities becomes more and more difficult as the disease progresses.
During cold seasons COPD patients, with their damaged lungs, are often susceptible to respiratory infections and pneumonia. If an acute infection sets, and this is one of the risks due to the debilitated physical state of the COPD sufferer as the lung function provides insufficient oxygen to the body, a hospital stay is often unavoidable.
At the beginning of the disease, the patient often produces phlegm, that is associated with sputum cough. This cough is sometimes dismissed as smoker’s cough or as a cold, and so receives little attention. Later on it becomes persistent and can be coughed up only with difficulty. Moreover breathlessness which at the beginning of the disease only occurs during physical exertion will also take place during rest as the disease progresses.
COPD not only affects the respiratory organs, but the whole organism. Many patients suffer additionally from cardio-vascular diseases, metabolic disorders and depression.
When these typical symptoms occur suggesting to your doctor that COPD is present, he or she will usually first give you a series of questions relating to the nature and duration of symptoms, smoking habits and other risk factors. The next step will be a physical examination that will include the typical lung sounds or a prolonged exhalation test. In later stages the type of symptoms will include cyanotic (blue colored) lips, edema or emaciation (meaning loss of much needed fat and often muscle tissue, making that organism look extremely thin).
This is usually preceded by a pulmonary function test, which is determined by whether a limited respiratory function is present at rest or during exercise. Among other things, it examines how much of the inhaled air can be exhaled in the first and second attempt. (2)
If the ratio of exhaled to inhaled air is less than 70%, this might indicate an obstructive lung disease, since in such a condition, the volume of inspired air remains the same, but exhalation is causing difficulty in breathing.
During this examination they will also examine the so-called bronchodilators, (drugs for dilation of the bronchi), to determine if there is an improvement in values. In this way reversible narrowing of the airways are excluded (Eg. asthma).
Another part of the examination will be a blood gas analysis to verify whether the uptake of oxygen into the blood and the release of carbon dioxide from the blood is impaired. Usually a sample is taken after a rest period and one under stress conditions (Eg after a six-minute walk test) and analyzed.
If the values are not appropriate, in other words the proportion of carbon dioxide is high and the proportion of oxygen is low this can be counteracted with oxygen therapy.
Valuable information is also recovered for the diagnosis by imaging techniques such as radiography (X-rays) , computer tomography and ultrasound examinations. These types of examination look to identify complications that can occur in COPD. These include, for example, pneumonia, pulmonary embolism or changes in the heart. For heart examination an electrocardiogram (ECG) will be ordered.
Depending on the severity of the symptoms chronic obstructive pulmonary disease (COPD) can be divided into different grades. The classification is based on the FEV1 ratio that describes the volume of air exhaled during the first and second breath (the so-called forced expiratory volume). FEV1 can be collected in a test of lung function (spirometry). The normal FEV1 ratio is around 80%. (3)
- The grade 0 is when spirometry shows no abnormalities, but there are chronic symptoms such as cough and sputum.
- Grade I (Mild) occurs when the FEV1 is less than 80 percent of the reference. Chronic symptoms need not be present.
- Grade II (intermediate) occurs when the FEV1 is between 50 and 80 percent of the nominal value.
- Grade III (severe) occurs when the FEV1 of between 30 and 50 percent of the nominal value is.
- Gade IV (very severe) occurs if the measured FEV1 value is less than 30 percent of the reference value and at the same time, the patient suffers from a chronic respiratory insufficiency.