Maryland General Logo
 
spacer

  home button seperater Medical Services Button seperater seperater seperater seperater

 

Home > Medical Reference > Patient Education

Services at Maryland General

A complete list of inpatient and outpatient healthcare services at MGH.

Chronic obstructive pulmonary disease - Symptoms

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of COPD -- emphysema and/or chronic bronchitis.

Alternative Names

COPD; Alpha-1 antitrypsin deficiency; Bronchitis - chronic; Chronic bronchitis; Emphysema

Symptoms:

The hallmark symptom of COPD is shortness of breath that gets worse over time. It is often accompanied by a phlegm-producing cough and episodes of wheezing. Symptoms may vary, however, or others may be present, depending on the disease involved. Many patients have symptoms of both chronic bronchitis and emphysema.

Symptoms of Emphysema

Typically, the first symptoms of emphysema occur in heavy smokers in their mid-50s:

  • The main early symptom is shortness of breath with light physical activity. Coughing is usually minor, and coughs produce little sputum (phlegm).
  • Late, severe symptoms include rapid, labored breathing and persistent craving for air (air hunger), even during rest or after minimal physical activity.
  • Patients are often very thin (a wasted look called "cachexia"), have pinkish skin, and tend to breathe through pursed lips.
  • Involuntary weight loss and muscle wasting may occur, and can indicate a poor outlook.

Symptoms of alpha-1 antitrypsin-related emphysema tend to appear between the ages of 30 and 40. Similar to the symptoms of emphysema, they include:

  • Inability to exercise without becoming winded
  • Shortness of breath after physical activity
  • Wheezing

Symptoms of Chronic Bronchitis

Chronic bronchitis usually causes the following symptoms:

  • Coughing with excessive phlegm occurs on most days for at least 3 months of the year, during 2 consecutive years. Coughing often starts before shortness of breath.
  • Shortness of breath occurs, but it may not be as severe during rest as it is in people with emphysema.
  • Lying down at night worsens symptoms in severe bronchitis, so patients sleep sitting up.
  • In late, severe stages, lack of oxygen causes the skin to have a blue color (cyanosis).
  • The body may swell from fluid build-up caused by heart failure.

Chronic cough is the hallmark symptom of chronic bronchitis starting in its early stages.

Resources

References

Aaron SD, Vandemheen KL, Fergusson D, et al, for the Canadian Thoracic Society/Canadian Respiratory Clinical Research Consortium. Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2007;146(8):545-555.

Anthonisen N. Chronic Obstructive Pulmonary Disease. In: Goldman L, Auseillo D. Goldman: Cecil Medicine. Philadelphia, PA: Saunders Elsevier; 2007:chap 88.

Calverly PM, Anderson JA, Celli B, et al, for the TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356(8):775-789.

Celli BR, Thomas NE, Anderson JA, Ferguson GT, Jenkins CR, Jones PW, et al. Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: results from the TORCH study. Am J Respir Crit Care Med. 2008;178:332-338.

De Jong Y, Uil SM, Grotjohan HP, Postma DS, Kerstjens HAM, Van den Berg JWK. Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study. Chest. 2007;132:1741-1747.

De Voogd JN, Wempe JB, Koëter GH, Postema K, van Sonderen E, Ranchor AV, et al. Depressive symptoms as predictors of mortality in patients with COPD. Chest. 2009/135:619-625.

Dimopoulos G, Siempos II, Korbila IP, Manta KG, Falagas ME. Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a meta-analysis of randomized controlled trials. Chest. 2007;132:447-455.

Fan VS, Ramsey SD, Giardino ND, Make BJ, Emery CF, Diaz PT, et al. Sex, depression, and risk of hospitalization and mortality in chronic obstructive pulmonary disease. Arch Intern Med. 2007;167:2345-2353.

Han MK, Postma D, Mannino DM, Giardino ND, Buist S, Curtis JL, et al. Gender and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007;176:1179-1184.

Kang MJ, Lee CG, Lee JY, Dela Cruz CS, Chen ZJ, et al. Cigarette smoke selectively enhances viral PAMP- and virus-induced pulmonary innate immune and remodeling responses in mice. J Clin Invest. 2008;118:2771-2784.

Kempainen RR, Savik K, Whelan TP, Dunitz JM, Herrington CS, Billings JL. High prevalence of proximal and distal gastroesophageal reflux disease in advanced COPD. Chest. 2007;131:1666-1671.

Laviolette L, Lacasse Y, Doucet M, et al. Chronic obstructive pulmonary disease in women. Can Respir J. 2007;14(2):93-98.

Lee TA, Pickard AS, Au DH, Bartle B, Weiss KB. Risk for death associated with medications for recently diagnosed chronic obstructive pulmonary disease. Ann Intern Med. 2008;149:380-390.

Nannini L, Cates CJ, Lasserson TJ, Poole P. Combined corticosteroid and long-acting beta-agonist in one: inhaler plus placebo for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2007;Oct 17;(4):CD003794.

Niewoehner DE, Lokhnygina Y, Rice K, et al. Risk indexes for exacerbations and hospitalizations due to COPD. Chest. 2007;131:20-28.

Pillai SG, Ge D, Zhu G, Kong X, Shianna KV, Need AC, et al. A genome-wide association study in chronic obstructive pulmonary disease (COPD): identification of two major susceptibility loci. PLoS Genet. 2009;5(3):e1000421.

Qaseem A. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;147:633-638.

Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532-555.

Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007;131:4S-42S.

Rizkallah J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis. Chest. 2009;135:786-793.

Sadaghnejad A, Ohar JA, Zheng SL, Sterling DA, Hawkins GA, Meyers DA, et al. ADAM33 polymorphisms are associated with COPD and lung function in long term tobacco smokers. Respir Res. 2009;10:21. [Epub ahead of print]

Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. JAMA. 2008;300:1439-1450.

Soltz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin guidance with standard therapy. Chest. 2007;131:9-19.

Stern DA, Morgan WJ, Wright AL, Guerra S, Martinez FD. Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study. Lancet. 2007;370:758-764.

Thabut G, Christie JD, Ravaud P, Castier Y, Brugière O, Fournier M, et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet. 2008;371:744-751.

Tsai CL, Clark S, Cydulka RK, Rowe BH, Camargo CA Jr. Factors associated with hospital admission among emergency department patients with chronic obstructive pulmonary disease exacerbation. Acad Emerg Med. 2007;13(1):6-14.

Wedzicha JA, Calverley PM, Seemungal TA, Hagan G, Ansari Z, Stockley RA. The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med. 2008;177:19-26.

Weinstein MS, Martin UJ, Crookshank AD, et al. Mortality and functional performance in severe emphysema after lung volume reduction or transplant. COPD. 2007;4(1):15-22.

Wilk JB, Chen TH, Gottlieb DJ, Walter RE, Nagle MW, Brandler BJ, et al. A genome-wide association study of pulmonary function measures in the Framingham Heart Study. PLoS Genet. 2009;5(3):e10000429.

Wilt TJ, Niewoehner D, MacDonald R, Kane RL. Management of stable chronic obstructive pulmonary disease: a systematic review for a clinical practice guideline. Ann Intern Med. 2007;147:141.

Xu W, Collet JP, Shapiro S, Lin Y, Yang T, Platt RW, et al. Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. Am J Respir Crit Care Med. 2008;178:913-920.

  • Reviewed last on: 4/20/2009
  • Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com
  
 
Physician Directory
seperater
Physician Specialties
seperater
Medical Glossary
seperater
Guide for Patients
seperater
Guide for Visitors
seperater
 
   
 

About Us    ·     Contact Us     ·     Phone Listing     ·     Residency Programs     ·     Site Map     ·     Site Search     ·     Links     ·     FAQs

© 2008 Maryland General Hospital, All Rights Reserved   ·   827 Linden Avenue,   Baltimore, MD 21201   ·   410-225-8000
Commitment to Compliance   ·   Privacy Policy   ·   Terms and Conditions of Use   ·   Disclaimer   ·   JCAHO Public Notice