7 Signs Your COPD Is Getting Worse

Changes in typical symptoms associated with the condition may mean you’re having a flare-up (exacerbation), or they could mean the disease is progressing.

Frequent coughing or wheezing, excess mucus, and shortness of breath are hallmark symptoms of chronic obstructive pulmonary disease (COPD).

While there are treatment options and lifestyle approaches to improve symptoms, there is no cure. COPD symptoms gradually get worse over time.

But they can also flare up suddenly, which is called an exacerbation. “Exacerbations are often triggered by respiratory infections, which could be viral or bacterial,” says Meredith McCormack, MD, a professor of medicine at Johns Hopkins Medicine in Baltimore. “They can also be triggered by exposures, like if someone has an increased exposure to pollution or secondhand smoke,” she says.

Frequent exacerbations are an indication that a person’s COPD is getting worse. Here are seven signs to watch for.

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 medical director of the pulmonary function laboratory 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 Dr. McCormack. “In more severe cases it might require an emergency room visit or hospitalization,” she says.

2. Wheezing

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.

While not everyone who has COPD has wheezing, research has linked wheezing to 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.

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 has 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 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.”

6. Edema

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 either pulmonary hypertension or right-sided heart failure. Those conditions are caused by a combination of not enough oxygen, inflammation, and high pressure on the blood vessels in the lungs and heart that can happen as a result of emphysema.

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.
“Sleep apnea or sleep disordered breathing is a frequent comorbidity with COPD and should be treated to avoid exacerbations,” says McCormack.

The Takeaway

A sudden increase in COPD symptoms such as shortness of breath, coughing, and edema may mean you’re having an exacerbation. Frequent exacerbations or a gradual increase in symptom severity can be an indication the condition is progressing. If you notice worsening symptoms, talk to your doctor about whether you need to change your treatment.

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1. Increased Shortness of Breath