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

Normal Lung and Emphysemic Lung

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Early Symptoms of COPD


The increased work of breathing and lower oxygen may make you tired with activities, or all the time.


Cough that produces a lot of mucus is a common symptom of COPD. Coughing may be worse during a cold or respiratory infection.

Sputum Production

More common with chronic bronchitis type. Production increases over time.


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. 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. 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.

Blueness of the lips or fingernail beds

As your ability to take in oxygen gets worse, it may become low enough to change the color of your lips and fingernails. This is called cyanosis.

Heart Problems

COPD makes the heart work harder, especially the right side of the heart. This side 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 be disturbed. Lack of oxygen in your blood can produce a bluish tinge to your skin, nails, and lips.

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. This causes 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 serious, further compromising breathing ability.


COPD. EBSCO DynaMed Plus website. Available at: Updated September 1, 2018. Accessed October 15, 2018.

What are the signs and symptoms of COPD? National Heart, Lung, and Blood Institute website. Available at: Accessed October 15, 2018.

Patient Education: Teaching the Patient with Chronic Obstructive Pulmonary Disease (COPD). EBSCO Nursing Reference Center website. Available at: Updated March 28, 2018. Accessed October 15, 2018.

Last reviewed March 2018 by Michael Woods, MD, FAAP  Last Updated: 3/30/2018