Symptoms

When you have COPD:

• You have a cough that won't go away.
• You often cough up mucus.
• You are often short of breath, especially when you exercise.
• You may feel tightness in your chest.

COPD exacerbation

Many people with COPD have attacks called flare-ups or exacerbations (say "egg-ZASS-er-BAY-shuns"). This is when your usual symptoms quickly get worse and stay worse. A COPD flare-up can be dangerous, and you may have to go to the hospital.

Symptoms include:

• Coughing up more mucus than usual.
• A change in the color or thickness of that mucus.
• More shortness of breath than usual.
• Greater tightness in your chest.

These attacks are most often caused by infections—such as acute bronchitis and pneumonia—and air pollution.

Work with your doctor to make a plan for dealing with a COPD flare-up. If you are prepared, you may be able to get it under control. Try not to panic if you start to have one. Quick treatment at home may help you manage serious breathing problems.

The stages of COPD

The stages of COPD are often defined according to your symptoms plus a measure of how well your lungs work, called your "lung function."

In the following symptoms lists, lung function FEV1 is a test result that shows how fast you can breathe air out of your lungs. FEV1 stands for forced expiratory volume in 1 second.

FEV1 can be measured by machines called spirometers (say "spy-RAW-muh-terz"). The test result is reported as a percentage of normal. In other words, an FEV1 of 100% means the lungs are working normally; 80% is less than normal; 30% is very much less than normal.

FVC (forced vital capacity) is another value obtained by spirometry. It is a measure of how much air can be blown out after inhaling in. Sometimes the FEV1/FVC ratio is used to confirm a diagnose of COPD or other lung diseases.

Here is how the stages of COPD are described by the Global Initiative for Chronic Obstructive Lung Disease, also known as GOLD:⁵

Mild COPD (stage 1)

• Usually, but not always, a chronic cough that may bring up mucus from the lungs
• Lung function FEV1 of 80% of normal or higher
• FEV1/FVC ratio less than 0.7

Moderate COPD (stage 2)

• Shortness of breath, especially with exercise
• Sometime a chronic cough that can bring up mucus
• An occasional COPD flare-up
• Lung function FEV1 of 50% to 79%
• FEV1/FVC ratio less than 0.7

Severe COPD (stage 3)

• Shortness of breath
• Fatigue and a reduced ability to exercise
• Repeated and sometimes severe COPD flare-ups
• Lung function FEV1 of 30% to 49%
• FEV1/FVC ratio less than 0.7

Very severe COPD (stage 4)

• Severe shortness of breath
• Weight loss
• Fluid buildup in the legs and feet (called edema)
• Life-threatening COPD flare-ups
• Lung function FEV1 of less than 30%, or of less than 50% along with chronic respiratory failure (a condition caused by carbon dioxide that stays in the lungs)
• FEV1/FVC ratio less than 0.7

COPD and asthma

Some people with COPD may have asthma too. But the two conditions differ in a number of ways, including how old you are when you get the disease and what triggers an attack.