COPD: Symptoms, stages, therapy

Brief overview

Symptoms: Shortness of breath, cough, sputum
Stages: physicians distinguish four degrees of severity (gold 1-4) with increasing symptom burden to permanent shortness of breath at rest.
Causes and risk factors: Mainly smoking (chronic smoker’s cough), also air pollution and certain lung diseases
Diagnosis: Pulmonary function test, blood gas analysis, X-ray examination of the chest (chest X-ray), blood values
Treatment: Complete smoking cessation, bronchodilator and anti-inflammatory medications, exercise, respiratory and physical therapy, long-term oxygen therapy, surgery (including lung transplantation)
Course and prognosis: Depends on whether the progression of the lung disease can be slowed down. The most important element is to stop smoking.
Prevention: The most important measure is to abstain from nicotine.

What is COPD?

COPD is often trivialized as “smoker’s lung” or “smoker’s cough.” Yet COPD is a serious lung disease that, once started, progresses and often leads to premature death.

COPD is widespread, with estimates suggesting that almost twelve percent of all people worldwide suffer from the disease. This makes COPD not only the most common chronic respiratory disease, but one of the most common diseases of all.

COPD mainly affects people over the age of 40. However, experts believe that younger people will also be increasingly affected in the future, as many young people start smoking at a very early age – the most important risk factor for COPD.

COPD is caused by inhaling tobacco smoke in about 90 percent of cases.

COPD: Definition and important terms

What exactly is COPD? The abbreviation stands for the English term “chronic obstructive pulmonary disease”. In German, it means “chronic obstructive pulmonary disease.” Obstructive means that the airways are narrowed as a result of the disease. This condition cannot be completely reversed even with medication. COPD therefore remains lifelong and is still not curable.

The lung disease COPD is usually a combination of chronic obstructive bronchitis (COB) and emphysema. According to the World Health Organization (WHO), chronic bronchitis, i.e. a permanent inflammation of the bronchial tubes, is present if cough and sputum persist for at least three months in each of two consecutive years. In about one in five patients, chronic narrowing of the airways also occurs. Doctors then speak of chronic obstructive bronchitis.

The term exacerbation is also frequently used in connection with COPD. It stands for an episodic, sudden worsening of COPD. Symptoms such as chronic cough, shortness of breath and mucus-like sputum increase acutely. Exacerbations are a stressful and threatening event for many sufferers. Exacerbated COPD is a sign that lung function is deteriorating rapidly. If the exacerbation is associated with an infection, doctors also refer to it as infectacerbated COPD.

COPD itself is not contagious, unlike respiratory infections that promote COPD or lead to an exacerbation. Neither is COPD hereditary. However, some people have an increased risk of developing COPD due to another inherited lung condition, alpha-1 antitrypsin deficiency.

What are the symptoms of COPD?

The main typical COPD symptoms include:

Shortness of breath, initially only with exertion, later also at rest.
Cough, which becomes worse and more persistent over time.
Sputum that becomes more viscous and increasingly difficult to cough up.

People with advanced disease also frequently suffer from chronic fatigue, weight loss and inappetence. Mental health problems, especially depression and anxiety, are also more common.

COPD symptoms: pink buffer and blue bloater

According to the external appearance of COPD sufferers, two types can be distinguished in principle: the “pink puffer” and the “blue bloater”. However, these are two clinical extremes; in reality, predominantly mixed forms occur:

Type	Appearance
Pink Buffer	In the “pink wheezer,” emphysema is the primary condition. The overinflated lungs lead to constant shortness of breath, which overstrains the respiratory support muscles. The affected person therefore expends an extremely large amount of energy breathing. The typical “pink buffer” is therefore underweight. Occasionally, an irritable cough occurs. The oxygen levels in the blood are not decreased because sufficient carbon dioxide is exhaled. The most common cause of death is respiratory failure.
Blue Bloater

COPD symptoms of an exacerbation

During the course of COPD, many people experience a recurrent acute worsening of COPD symptoms (exacerbation). Exacerbations can be divided into three levels of severity: mild, moderate, and severe. In these cases, COPD symptoms go beyond the normal level of diurnal fluctuation and usually last longer than 24 hours.

Signs of worsening COPD symptoms are:

Increase in shortness of breath
@ Increase in coughing
Increase in sputum
Change in color of sputum (yellow-green sputum is a sign of a bacterial infection)
General malaise with fatigue and possibly fever
Chest tightness

Signs of a severe exacerbation are:

Shortness of breath at rest
Decreased oxygen saturation in the lungs (central cyanosis)
Use of auxiliary respiratory muscles
Water retention in the legs (edema)
Clouding of consciousness until coma

COPD symptoms increase in the fall and winter. Any acute exacerbation poses a potential threat to the life of the affected person, as there is a risk of lung failure within a short period of time with increasing oxygen deficiency and exhaustion of the respiratory muscles. For sufferers with acute worsening of COPD symptoms, it is therefore advisable to be examined by a doctor as a matter of urgency – they need more intensive treatment.

However, if your condition worsens (increase in cough, sputum and/or shortness of breath), it is best to consult your doctor immediately. This way, deterioration and complications can be detected and treated in time.

COPD symptoms due to complications and concomitant diseases

As the disease progresses, the lung disease often affects other organs and leads to various complications and concomitant diseases. These in turn become noticeable through additional symptoms:

Infections and shortness of breath: Long-standing COPD typically results in frequently recurring bronchial infections and pneumonia. Decreased lung function also leads to constant shortness of breath.

Cor pulmonale: In the late stages of COPD, cor pulmonale often occurs: the right side of the heart enlarges and loses its functional strength – a right-sided cardiac insufficiency develops. The consequences of this include water retention in the legs (edema) and in the abdomen (ascites) as well as congested neck veins. The water retention is most noticeable in the swelling and thickening of the abdomen and legs. In some circumstances, there is also a sudden increase in weight.

Serious, life-threatening complications of cor pulmonale include heart failure and respiratory muscle failure.

Drumstick fingers and watch glass nails: So-called drumstick fingers with watch glass nails sometimes occur on the hands in COPD. These are rounded finger end links with curved fingernails. They are the result of a reduced oxygen supply.

Barrel thorax: Barrel thorax is one of the typical pulmonary emphysema symptoms. In this case, the chest is shaped like a barrel, and the front ribs run almost horizontally.

In many people, advanced COPD affects the musculature, skeleton and metabolism. This leads to further symptoms such as muscle loss, weight loss or anemia. Pain, especially back pain due to overworked respiratory muscles, is also among the possible symptoms of COPD.

What are the stages of COPD?

Before 2011, only lung function limitation and symptoms were decisive for the so-called GOLD COPD stages. At the end of 2011, a new classification of COPD was presented by the GOLD (Global Initiative for Chronic Obstructive Lung Disease). It additionally considered the frequency of sudden worsening of COPD (exacerbation rate) and the outcome of patient questionnaires in the staging.

COPD stages: classification until 2011

There are a total of four COPD stages. Until 2011, the classification was based on lung function, which is measured using the spirometer. The one-second capacity (FEV1) is determined. This is the maximum possible lung volume that the affected person exhales within one second.

Severity	Symptoms	One second capacity (FEV1)
COPD 0	Chronic symptoms:	inconspicuous
COPD 1	With or without chronic symptoms:	inconspicuous (not below 80 percent
COPD 2	With or without chronic symptoms:	restricted
COPD 3	With or without chronic symptoms:	restricted
COPD 4	chronic insufficient oxygen supply	severely restricted

COPD 1

When the one-second capacity is less than 80 percent of normal, doctors refer to it as mild COPD, i.e., COPD grade I. Typical symptoms are usually a chronic cough with increased mucus production. Sometimes, however, there are no symptoms at all. As a rule, there is no shortness of breath. Often, those affected do not even know that they have COPD.

COPD 2

COPD 3

This stage of COPD is already severe COPD: many alveoli are already no longer functional. The one-second capacity is between 30 and 50 percent of the normal value. The symptoms of coughing and expectoration are more noticeable, and sufferers get out of breath even on slight exertion. However, there are also sufferers who continue to have no cough or sputum.

COPD 4

If the one-second capacity is below 30 percent of the normal value, the disease is already far advanced. The affected person is in the COPD end stage, i.e. COPD grade IV. The oxygen content in the blood is very low, which is why sufferers experience shortness of breath even at rest. As a sign of end-stage COPD, right heart damage may already have developed (cor pulmonale).

COPD GOLD stages: Classification as of 2011

A revised classification of COPD GOLD stages from 2011 continued to be based on lung function, measured by one-second capacity. In addition, however, GOLD now took into account the frequency of exacerbations as well as symptoms recorded using a questionnaire (COPD Assessment Test), such as shortness of breath or reduced exercise capacity. According to the new findings, four patient groups emerged: A, B, C, and D.