Symptoms and signs may include:

• Fatigue
• Dyspnea 
• Paroxysmal nocturnal dyspnea (PND)
• Chest tightness
• Wheezing
• Cough with sputum (mucoid and/or purulent)
• Fever
• Chest pain

• Fatigue

  Emphysema and chronic bronchitis can be difficult to tell apart since each causes the restriction of breathing as well as symptoms of fatigue, wheezing, and excessive mucus production. [verywell.com]

  Authors' conclusions: Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition. [cochrane.org]

  Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition. These improvements are moderately large and clinically significant. [ncbi.nlm.nih.gov]

  People with COPD may have difficulty breathing, chronic cough, fatigue, and chest tightening. COPD can also result in reduced blood oxygen levels, causing fatigue and leading to adverse health conditions. [sleepfoundation.org]

  Figures and Tables - Analysis 1.1 Comparison 1 Rehabilitation versus usual care, Outcome 1 QoL ‐ Change in CRQ (Fatigue). [dx.doi.org]

• Weight Loss

  Roflumilast in particular was associated with weight loss during the trial period and an increase in insomnia and depressive mood symptoms. [ncbi.nlm.nih.gov]

  Severe cases may be complicated by weight loss, pneumothorax, frequent acute decompensation episodes, right heart failure, and acute or chronic respiratory failure. [web.archive.org]

  Stop smoking Stay away from irritants in the air such as cigarette smoke, air pollution, and pollen Talk to your doctor about getting a flu and pneumonia shot (vaccination) Eat healthy foods every day, especially if you have unexplained weight loss Drink [merckmanuals.com]

  Read More 7 Ways to Gain Weight If You Have COPD Although weight loss sounds like a good thing, it's not—if you have chronic obstructive pulmonary disease. [health.com]

• Anemia

  Clinical laboratory tests showed microcytic anemia (hemoglobin 10g/dl), plasma sodium 111mEq/l (normal value [NV]: 135–155mEq/l), plasma osmolarity 229mOsm/l (NV: 280–300), PCR 64mg/l (NV: 0–5), normal creatinine levels, urinary sodium 76mEq/l (NV: 54 [archbronconeumol.org]

  Also, older age, heart disease, anemia, resting tachycardia, hypercapnia, and hypoxemia decrease survival, whereas a significant response to bronchodilators predicts improved survival. [msdmanuals.com]

  Treatment, depending on severity of symptoms, typically starts with anticoagulants; the presence of ominous signs (low blood pressure) may warrant the use of thrombolytic drugs.[2] Anemia[edit] Anemia that develops gradually usually presents with exertional [en.wikipedia.org]

• Chronic Fatigue Syndrome

  […] of energy or chronic fatigue syndrome Producing a lot of mucus or phlegm Having to clear your throat first thing in the morning, due to excess mucus in your lungs Unintended weight loss (in later stages) If you have one or more of these symptoms on a [draxe.com]

  Chronic fatigue syndrome (CFS). Depression. Epilepsy. Headaches. Heartburn. Hypertension. Infertility. Parkinson's disease. Psoriasis. Rheumatoid arthritis. Schizophrenia. Other conditions. [medlineplus.gov]

  Chronic fatigue syndrome (CFS). Depression. Epilepsy. Headaches. Heartburn. Hypertension. Infertility. Parkinson’s disease. Psoriasis. Rheumatoid arthritis. Schizophrenia. Other conditions. [web.archive.org]

• Chills

  An 80-year-old Japanese man with chronic obstructive pulmonary disease and congestive heart failure visited the Kariya Toyota General Hospital, Aichi, Japan with the chief complaint of fever accompanied by chills and left leg pain. [ncbi.nlm.nih.gov]

  […] wheezing more Chest feels tight or “full” (call 911 immediately if you have chest pain or severed chest tightness) Some trouble with daily activities Trouble concentrating No appetite Feeling very tense or restless Sore throat and runny nose Fever and chills [intermountainhealthcare.org]

• Cough

  The cilia help move mucus up the tubes so it can be coughed out. In chronic bronchitis, the tubes have lost their cilia. This makes it hard to cough up mucus, which causes more coughing. More coughing makes the tubes more irritated. [copdfoundation.org]

  BACKGROUND: Cough and sputum production (symptoms of bronchitis) are common in chronic obstructive pulmonary disease (COPD). [ncbi.nlm.nih.gov]

  Chronic bronchitis It is defined clinically as persistent productive cough for at least 3 months in 2 (or more) consecutive years. [symptoma.com]

  These include the following: Coughing every day over a period of months. Smokers often refer to this as "smoker's cough." [rush.edu]

• Dyspnea

  MEASUREMENT OF DYSPNEA IN COPD Section: The two purposes of measuring dyspnea are: to differentiate between patients who have less dyspnea and those who have more dyspnea (discriminate), and to determine whether dyspnea has changed over time and/or as [dx.doi.org]

  Thus, hyperinflation is directly associated with patient-centered outcomes such as dyspnea and exercise limitation. [ncbi.nlm.nih.gov]

  With this continuous method the patient reports twice the number of dyspnea ratings during exercise compared with discrete ratings each minute. [oadoi.org]

• Sputum Production

  Chronic cough and sputum production often precede the development of airflow limitation by many years, although not all individuals with cough and sputum production go on to develop COPD. [who.int]

  The diagnosis of chronic obstructive pulmonary disease (COPD) should be suspected in patients with risk factors (primarily a history of smoking) who report dyspnea at rest or with exertion, chronic cough with or without sputum production, or a history [ncbi.nlm.nih.gov]

• Chronic Cough

  This case report emphasizes that not all chronic cough and dyspnea are attributable to COPD. [ncbi.nlm.nih.gov]

  The most common symptoms of COPD are breathlessness, or a 'need for air', excessive sputum production, and a chronic cough. [who.int]

• Productive Cough

  Symptoms are productive cough and dyspnea that develop over years; common signs include decreased breath sounds, prolonged expiratory phase of respiration, and wheezing. [web.archive.org]

  We report a 55-year-old male ex-smoker who presented with complaints of exertional breathlessness and productive cough for five years and an episode of haemoptysis four days prior to presentation. [ncbi.nlm.nih.gov]

  Chronic, productive cough (with mucus) A feeling of "tightness" in the chest Wheezing [my.clevelandclinic.org]

  Chronic bronchitis It is defined clinically as persistent productive cough for at least 3 months in 2 (or more) consecutive years. [symptoma.com]

• Heart Failure

  Heart failure shares some general symptoms with COPD; thus, diagnosing COPD is difficult in subjects with a history of heart failure, and spi-rometry is mandatory for confirmation. [ncbi.nlm.nih.gov]

• Cyanosis

  Cf Blue bloater. pink puffer A facetious term sometimes used by doctors to describe patients breathless from CHRONIC lung disease but still able to maintain sufficient oxygenation of the blood to avoid CYANOSIS. Compare BLUE BLOATER. [medical-dictionary.thefreedictionary.com]

  The is caused by the lack of oxygen in the bloodstream, a condition known as cyanosis. Decreased oxygen can also lead to the swelling in the legs and ankle ( peripheral edema ). [verywell.com]

  Other possible COPD symptoms include a lack of energy; unintentional weight loss in later stages; swelling in ankles, feet or legs; and cyanosis (lips or fingernails take on a bluish hue). COPD causes The causes of COPD are not fully understood. [copdnewstoday.com]

  In addition to severe COPD symptoms, signs of end-stage COPD include: Blueness of the lips or fingernail beds (cyanosis) Chronic respiratory failure Treatment may require oxygen therapy or surgery. [everydayhealth.com]

• Chest Pain

  PE should receive increased awareness in patients with unexplained AE-COPD, especially when pleuritic chest pain and signs of cardiac failure are present, and no clear infectious origin can be identified. [ncbi.nlm.nih.gov]

  Symptoms Morning cough is often the earliest sign of the disease, followed by noisy breathing, chest pain, and breathlessness. People with COPD sometimes develop a barrel-shaped chest due to an enlargement of the lungs. [sleepfoundation.org]

  Symptoms and signs may include: Fatigue Dyspnea Paroxysmal nocturnal dyspnea (PND) Chest tightness Wheezing Cough with sputum (mucoid and/or purulent) Fever Chest pain Workup consists of a detailed history, tests and physical examination. [symptoma.com]

  Other symptoms Less common symptoms of COPD include: weight loss tiredness swollen ankles from a build-up of fluid (oedema) chest pain and coughing up blood – although these are usually signs of another condition, such as a chest infection or possibly [nhs.uk]

  Conversely, a 20-year-old healthy man with sudden onset of severe, sharp chest pain and back pain may be suspected of having a dissecting thoracic aortic aneurysm because those clinical features are common in aortic dissection. [msdmanuals.com]

• Tachycardia

  The severity of COPD correlates with various arrhythmic manifestations such as atrial fibrillation, atrial flutter, and either sustained or nonsustained ventricular tachycardia. [ncbi.nlm.nih.gov]

  The lack of oxygen combined with the build-up of carbon dioxide can lead to a myriad of symptoms, including: Shortness of breath Wheezing Persistent cough Excessive mucus production Chronic fatigue Rapid heartbeat ( tachycardia ) More than four million [verywell.com]

  […] was known to be associated with mild decreased heart rate variability, 10 which is a known risk factor for cardiac mortality and sudden cardiac death. 11 The Lung Health Study investigators reported a RR for hospitalisations due to supraventricular tachycardia [dx.doi.org]

  QRS complexes <5 mm in the limb leads or <10 mm in the precordial leads right ventricular hypertrophy right axis deviation dominant R wave in V1 with an amplitude >7 mm often associated with "P pulmonale" (right atrial enlargement) multifocal atrial tachycardia [radiopaedia.org]

• Lip Cyanosis

  The consequence of these changes is a limitation of airflow. [13] Patients with advanced COPD that have primarily chronic bronchitis rather than emphysema were commonly referred to as "blue bloaters" because of the bluish color of the skin and lips (cyanosis [physio-pedia.com]

• Hepatomegaly

  Affected infants may present in the newborn period with cholestatic jaundice, sometimes with acholic stools (pale or clay-coloured) and hepatomegaly. [dx.doi.org]

• Osteoporosis

  Overtreatment with inhaled corticosteroids exposes these patients to an increased risk of potentially severe side-effects such as pneumonia, osteoporosis, and oropharyngeal candidiasis. Moreover, it represents a major waste of health-care spending. [ncbi.nlm.nih.gov]

  If the air pocket bursts during a coughing fit, the lung will deflate heart problems – the heart has to work extremely hard to pump blood through the damaged lungs osteoporosis – where bones become thin and break more easily. [betterhealth.vic.gov.au]

  Although primarily a lung disease, it is increasingly recognized that COPD has secondary associations, including muscle weakness and osteoporosis. [britannica.com]

  Prevention of osteoporosis is important and starts with avoiding unnecessary treatment, particularly corticosteroids. [nps.org.au]

• Irritability

  Whatever the exact cause may be, the common factor is airway irritation, which leads to inflammation and then damage. [symptoma.com]

  Chronic bronchitis Chronic bronchitis is irritation and inflammation (swelling) of the lining in the bronchial tubes (air passages). The irritation causes coughing and an excess amount of mucus in the airways. [my.clevelandclinic.org]

  Other irritants that may contribute to COPD include second-hand smoke, air pollution, and exposure to chemical fumes in the workplace. [medicare.com]

  Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs. Exposure to fumes from burning fuel. [mayoclinic.org]

• Headache

  The patient may develop a morning headache that indicates too much carbon dioxide in their blood. There may also be a loss of weight. Causes and Risk Factors COPD is most commonly caused by tobacco smoke. [cedars-sinai.edu]

  0.0075 15 μg every 12 hrs COPD, bronchitis, emphysema (≥5%) Chest pain, back pain, headache, diarrhea, sinusitis $$$$$ Anticholinergics Short-acting Atrovent HFA (ipratropium) 17 MDI 2 inhalations 4 times daily COPD, bronchitis, emphysema Bronchitis [ncbi.nlm.nih.gov]

  […] your lungs), usually in the morning Shortness of breath when you exercise or move around In your 60s, you may have: More trouble breathing, especially if you smoke Pneumonia and other lung infections that may require hospital stays Weight loss Morning headaches [merckmanuals.com]

• Altered Mental Status

  mental status, unstable dysrhythmia, stridor, intercostal indrawing, cyanosis, tripod positioning, pronounced use of accessory muscles (sternocleidomastoid, scalenes) and absent breath sounds.[11] A number of scales may be used to quantify the degree [en.wikipedia.org]

  mental status Increase in hypoxemia or hypercapnia Inability to tolerate oral medications such as antibiotics or steroids See Treatment and Medication for more detail. [emedicine.com]

Workup consists of a detailed history, tests and physical examination.

Laboratory Tests

• Complete blood count
• Arterial blood gases
• Serum electrolytes
• Spirometry
• Serum BNP levels
• Sputum culture
• Pulmonary function tests
• Pulse oximetry

Imaging Studies

• Chest radiography
• CT scan

Test Results

On the results of laboratory tests and radiography, diagnosis is made and treatment is immediately begun.

• Pulmonary Infiltrate

  [Grade B] 8.11.12 Sickle cell crisis Patients with sickle cell disease frequently present with an acute painful crisis and less frequently with an “acute chest syndrome” comprising breathlessness, chest pain and fever with pulmonary infiltrates on the [dx.doi.org]

• Right Axis Deviation

  […] ventricular hypertrophy right axis deviation dominant R wave in V1 with an amplitude >7 mm often associated with "P pulmonale" (right atrial enlargement) multifocal atrial tachycardia In contrast to asthma, the histologic changes of COPD are irreversible [radiopaedia.org]

  Findings of right ventricular hypertrophy include an R or R′ wave as tall as or taller than the S wave in lead V1; an R wave smaller than the S wave in lead V6; right-axis deviation >110° without right bundle branch block; or some combination of these [msdmanuals.com]

• Poor R Wave Progression

  ECG poor R wave progression requires an R wave in V3 <3 mm clockwise rotation of the heart secondary to hyperinflation results in a delayed precordial transition zone the lead in which the R/S ratio becomes >1, usually occurring in V3 or V4, shifts laterally [radiopaedia.org]

• Hypercapnia

  Before mechanical ventilation, coma could be confirmed to be due to CO2 narcosis caused by exorbitant arterial hypercapnia (PCO2, 193 mm Hg). Pneumothorax was diagnosed in the hospital by chest x-ray and resolved after pleural drainage. [ncbi.nlm.nih.gov]

  These findings indicate that, under the conditions investigated, arteriolar renal resistances are increased, perhaps because of local adrenergic discharge secondary to hypercapnia. [thorax.bmj.com]

  Hypercapnia and Respiratory Acidosis A major complicance in COPD patients is the development of stable hypercapnia [6, 7]. [hindawi.com]

  All patients requiring hospitalization for an acute exacerbation should undergo testing to quantify hypoxemia and hypercapnia. Hypercapnia may exist without hypoxemia. [msdmanuals.com]

• Oxygen Saturation Decreased

  Low FEV1, smoking history, and obesity are factors associated with oxygen saturation decrease in an adult population cohort. International Journal of Chronic Obstructive Pulmonary Disease 2014;9(1):1225–1233. [kjan.or.kr]

• Right Bundle Branch Block

  Findings of right ventricular hypertrophy include an R or R′ wave as tall as or taller than the S wave in lead V1; an R wave smaller than the S wave in lead V6; right-axis deviation >110° without right bundle branch block; or some combination of these [msdmanuals.com]

• Decreased Vital Capacity

  Other test abnormalities may include Increased total lung capacity Increased functional residual capacity Increased residual volume Decreased vital capacity Decreased single-breath diffusing capacity for carbon monoxide (DLCO) Findings of increased total [msdmanuals.com]

• Increased Total Lung Capacity

  Other test abnormalities may include Increased total lung capacity Increased functional residual capacity Increased residual volume Decreased vital capacity Decreased single-breath diffusing capacity for carbon monoxide (DLCO) Findings of increased total [msdmanuals.com]

• P Pulmonale

  pulmonale" (right atrial enlargement) multifocal atrial tachycardia In contrast to asthma, the histologic changes of COPD are irreversible and gradually progress over time. [radiopaedia.org]

  pulmonale, an electrocardiographic finding. [ncbi.nlm.nih.gov]

Oxygen

In a cluster randomised, controlled parallel group trial, in 405 patients, titrated oxygen significantly reduced mortality, hypercapnia and respiratory acidosis [8].

Medications

Medications that can be used include:

• Bronchodilators: These are given in pumps, to be inhaled as many times as prescribed. 
• Corticosteroids: These are given to stop the inflammation from worsening. They can be used as inhalers (inhaled corticosteroids ICS) in mild to moderate disease, or given per oral in advanced disease. 
• Leukotriene inhibitors: To stop action of leukotrienes in the inflammatory pathway 
• Long-acting Beta 2 Agonists: Their use is associated with improved quality of life and reduced exacerbations, but they have not been shown to reduce mortality or serious adverse events significantly. [9]. 
• Antibiotics: For prophylactic treatment.

Cessation of smoking

Smoking should be immediately stopped to prevent the disease from worsening.

Removal of pollutants

Prolonged exposure to pollutants, such as smoke, asbestos, silica, etc should be avoided.

COPD is due to irreversible damage to the airways. This means this disease can be managed, not treated. Prognosis depends upon the stage of the disease and the treatment started. With appropriate treatment and cessation of smoking, COPD can be prevented from worsening and a relatively healthy life style can be adopted.

Complications

• Worsening of the condition/stage 
• Lung scarring and fibrosis
• Pneumonia
• Right sided heart failure
• Weight loss
• Arrhythmias 
• Pneumothorax
• Need for oxygen mask

In most patients, COPD is the result of long-term heavy cigarette smoking; about 10% of patients are nonsmokers [3]. Other causes may include alpha-1 anti-trypsin deficiency, bronchiectasis and cystic fibrosis. Exposure to large amounts of air pollutants may also lead to development of COPD.

Whatever the exact cause may be, the common factor is airway irritation, which leads to inflammation and then damage. This results first in mucosal and glandular changes in the airways, and as the disease progresses, these changes are unable to match up with the continuously on going irritation, and irreversible damage occurs. The type of COPD depends upon the exact causative factor.

Incidence

COPD is estimated to be the fourth leading cause of death in the United States and the sixth leading cause of death world wide.

Sex and Race

There is a clear cut association between heavy cigarette smoking and emphysema, and women and African-Americans are more susceptible than other groups [2]. However, generally men are much more commonly found to be suffering from COPD than women.

Age

COPD is more common in people, particularly men, aged 40 years and above.

COPD is a vast term that is used to describe three prominent disorders collectively. These include the following:

Emphysema

Emphysema is a condition of the lung characterised by irreversible enlargement of the air spaces distal to the terminal bronchiole, accompanied by destruction of their walls without obvious fibrosis [4].

Chronic bronchitis

It is defined clinically as persistent productive cough for at least 3 months in 2 (or more) consecutive years. The earliest feature of chronic bronchitis is hypersecretion of mucus in the large airways, associated with hypertrophy of the submucosal glands in the trachea and bronchi [5].

Asthma

It is a chronic inflammatory disorder in which patients suffer from recurrent episodes of wheezing, breathlessness and cough. Many cells play a role in the inflammatory response, in particular lymphocytes, eosinophils, mast cells, macrophages, neutrophils and epithelial cells [6].

Chronic bronchiolitis, or small airway disease, also comes under the COPD category and shares many characteristics with the former two conditions. In a recent study, the overlap between these three disorders was found to be substantial [7].

The use of continuous prophylactic antibiotics results in a clinically significant benefit in reducing exacerbations in COPD [10].
COPD can be easily prevented by not smoking tobacco and other such harmful agents. Also, avoiding exposure to pollutants can also prevent this disease from occurring.

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition involving the airways and characterised by airflow limitation [1]. It is diagnosed based on clinical findings and results of pulmonary function tests. In acute COPD, symptoms are mild and the disease is often missed. As the disease progresses, varying symptoms present in different people.

1. Buist AS, McBurnie MA,Volmer WM, et al. International variation in the prevalence of COPD (the BOLD study): a population based prevalence study. Lancet 2007;379:741
2. Cazzola M et al. One hundred years of chronic obstructive pulmonary disease (COPD). Respir Med 101:1049, 2007
3. Shaw RJ et al. The Role of small airways in lung disease. Respir Med 96:67, 2002
4. Snider G:The definition of emphysema:report of the National Heart, Lung and Blood Institute, Division of Lung Diseases Workshop. Am Rev Respir Dis 132:182, 1985
5. deMello DE, Reid L. Pathology of Pulmonary Disease. Philadelphia. JB Lippincott, 1994.
6. Bloemen K, et al. The allergic Cascade: review of the most important molecules in the asthmatic lung. Immunol Lett 113:6,2007
7. Ware LB: Pathophysiology of acute lung injury and the acute respiratory distress syndrome. Semin Respir Crit Care Med 27:337, 2006
8. Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R: Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital settings:randomised control trial. BMJ. Oct 18 2010;341:c5462
9. Kew KM, Mavergames C, Walters JA: Long acting beta2 agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013, Oct 15;10CD:010177. 
10. Herath SC, Poole P; Prophylactic antibiotic therapy for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013, Nov 28;11:CD009764