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8 Signs Your COPD May Be Worsening

Medically reviewed by Angelica Balingit, M.D.
Posted on August 31, 2023

Chronic obstructive pulmonary disease (COPD) is a progressive condition — symptoms can worsen over time, especially in the later stages. If you’re aware of signs that your health is changing, you can have more productive conversations with your doctor and seek new treatment options to protect your quality of life.

Here are some warning signs of COPD progression that might mean it’s time to discuss your treatment plan with your doctor.

1. Less Energy and More Fatigue

Lower energy levels and increasing fatigue can indicate worsening COPD. In stages 3 and 4, you may notice you get tired faster, and even simple tasks leave you wiped out. It may become challenging to engage in activities at the same level as before. You may need more rest breaks or assistance from others to manage household tasks.

“I’ve had COPD for eight years, and it went from moderate to severe,” shared a MyCOPDTeam member. “I can’t walk far. It’s too scary to be so out of breath. I use a walker. I work around the house and rest, then work around the house and rest. Today, I’m going to vacuum the mats in my car. It’ll take me forever!”

2. Increasing Shortness of Breath

As COPD progresses, dyspnea (breathlessness) tends to worsen. Walking short distances, climbing stairs, or getting dressed might trigger breathlessness, reducing your mobility and independence. In advanced stages of COPD, breathing in enough oxygen becomes harder. You may feel constantly breathless, even at rest, and notice chest tightness or chest pain. Some people might find that supplemental oxygen can help.

“I started on oxygen nine days ago, and along with the inhaler, I’m sleeping better and waking up feeling much better with a bit more energy,” a member of MyCOPDTeam said. “Also, I’ve been able to walk more and do some exercise. Right now, the oxygen has been set up for three months to see if it helps, but so far, it’s a big improvement.”

Although it can be disappointing to learn that your COPD is progressing, the right treatment plan can help you feel your best, regain some independence, and be more active. Make sure you understand which of your medications are for maintenance (long-acting) and which are for rescue (short-acting).

You might consider using a pulse oximeter to measure your blood’s oxygen levels at home. You can purchase these electronic devices online and at drugstores. According to the American Lung Association, a good saturation number is 90 percent to 92 percent. If you consistently get readings lower than that, contact your doctor, who can evaluate if you’re getting enough oxygen.

You must meet certain criteria to qualify for supplemental oxygen. Also, your shortness of breath could be related to another condition that won’t be relieved by oxygen. Your doctor can help figure out the cause and best treatment for your increasing shortness of breath.

3. Intolerance to Cold Temperatures

Cold air can make it harder to breathe as COPD progresses. Avoid outdoor activities if the cold triggers your COPD symptoms, and wear a scarf, mask, or other protective gear around your face if needed to help you breathe better when it’s chilly.

“A cold and snowy winter day is making breathing a bit more difficult here in the Northeast,” a MyCOPDTeam member said. “I’m looking forward to warmer, drier days. That combination provides much better breathing days.”

In addition, respiratory infections that may be more widespread during cooler months, like the common cold or flu, can have a greater impact. You’ll need to step up your precautions to avoid illness by getting the vaccinations recommended by your doctor, washing your hands often, and avoiding people who are sick.

4. More Frequent and Severe Symptoms

COPD exacerbations are sudden flare-ups of symptoms such as increased coughing, mucus and phlegm production, and shortness of breath. While these exacerbations can occur at any stage of COPD, they tend to occur more and can become life-threatening as the disease progresses.

Exacerbations are often triggered by:

  • Respiratory infections
  • Air pollution
  • Strong odors and fumes
  • Smoke

A significant increase in exacerbations can indicate a worsening condition. You may find yourself visiting the emergency room more often, and be sure to let your doctor know about increasingly frequent flare-ups.

5. Unintended Weight Loss

Weight loss can be a common symptom of COPD in more advanced stages. “I keep losing weight unless I really overeat,” said a MyCOPDTeam member.

Reduced energy levels and the increased effort required to breathe may lead to less appetite and unintentional weight loss. People with chronic coughing may have trouble chewing or swallowing their food, limiting how much they take in and possibly causing malnutrition. Other COPD-related factors such as inflammation, oxidative stress (having low levels of protective molecules called antioxidants), and steroid use can also lead to weight and muscle loss.

Weight loss can further weaken the body and affect overall health. Meeting with a registered dietitian nutritionist can help you learn strategies to ensure you get enough calories and protein to maintain a healthy weight.

6. Swollen Legs and Ankles

Worsening COPD can affect the heart, potentially leading to issues like pulmonary hypertension and heart failure. These cardiovascular diseases can cause fluid retention, resulting in edema (swelling) in your legs and ankles. You may notice that your shoes feel tight, and the swelling tends to worsen as the day progresses. Sudden weight fluctuations can be related to fluid buildup.

Some MyCOPDTeam members also described swollen feet and ankles when taking prednisone for a flare-up. Describing your symptoms to your health care team is the best way to decide if further testing or treatment is needed.

7. Reduced Response to Medications

In the later stages of COPD, you may find that your current medications are less effective in managing your symptoms. This may be due to disease progression or the development of drug tolerance. It’s crucial to communicate any changes in symptom control to your health care team. You may need a higher dose or additional medication.

8. Changes in Mood and Emotional Well-Being

As COPD progresses and daily activities become harder, feelings of depression, anxiety, and frustration can arise. COPD can be mentally taxing, and it’s essential to recognize the emotional impact of the disease and seek support when needed.

“I’m in end-stage COPD, and it’s very hard to wrap your mind around that,” shared one MyCOPDTeam member. “It’s depressing for sure. People don’t really understand the disease. If I’m having a good day, even though I’m on 24-hour oxygen, I can dress up and put makeup on just like I did when I worked. People think, ‘She can’t be sick — she looks so good.’ It doesn’t matter that I can barely hold a conversation and can’t walk across a room.”

It’s easy to feel isolated when others don’t understand your daily struggles. Getting mental health counseling or connecting with others via a support group, either in person or online — like MyCOPDTeam — can help validate how you’re feeling.

Partner With Your COPD Care Team

Regular communication with your COPD care team is essential to manage the disease. If your symptoms get worse, don’t hesitate to reach out to your health care provider. They can assess your condition, adjust medications, and provide valuable guidance. They may also recommend pulmonary rehabilitation.

Additionally, health care professionals often use the forced expiratory volume test to monitor disease progression objectively. This simple lung function test measures how much air you can forcefully exhale in one second and helps determine the stage of COPD.

Although COPD is a progressive lung disease, early recognition of worsening symptoms and proactive management can help you lead a fulfilling life. Be open with your health care providers and loved ones about changes in your health so that you get the treatment and support you need throughout your COPD journey.

Talk With Others Who Understand

On MyCOPDTeam, the social network for people with COPD and their loved ones, more than 119,000 members come together to ask questions, give advice, and share their stories with others who understand life with COPD.

Have your symptoms changed over time? Are you developing more COPD flare-ups, lung infections, or difficulty with physical activity than you used to? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on August 31, 2023

A MyCOPDTeam Member

My husband, after having COPD for years decided he was done
He passed away on June 17. His angel Gabrial told him he didn't need oxygen any more, but Satan said he did. Well, Gabriel won. He did… read more

posted July 2
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Angelica Balingit, M.D. is a specialist in internal medicine, board certified since 1996. Learn more about her here.
Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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