Cough is often a first sign of COPD and can be caused by inflammation and excess mucus production in the breathing tubes. Coughing is the body’s way of trying to get rid of excess mucus or irritants such as dust.

Changes to the cells of your breathing tubes caused by smoking can result in increased mucus production. If you notice a persistent rise in amount or change in the colour of your mucus, especially if it turns a dark yellow, green or red (presence of blood), you should notify your medical practitioner. Ask about Respiratory Physiotherapy if clearing mucus is a daily difficulty.

The experience of breathlessness varies between individuals with COPD. The causes of breathlessness in COPD are multi-factorial, and not always due to a lack of oxygen in the body.

Tips to manage breathlessness:

• Ceasing any current smoking will allow better air exchange in your lungs and relieve shortness of breath
• Avoid environments with second-hand smoke
• Stay hydrated to assist with keeping mucus thin and easier to clear
• Ask about breathing techniques such as pursed lip breathing or diaphragmatic breathing
• Rest by sitting down or leaning against a wall and familiarise yourself with positions that help your breathing
• Identify triggers of anxiety which may make breathlessness worse
• Utilise relaxation techniques
• Sleep upright to help increase the air flow
• Ensure your rooms are well ventilated or use an electric or handheld fan
• Supplemental oxygen may need to be considered in the course of your illness
• Find more information about managing breathlessness.

It’s important to discuss these tips with your health professional to determine which are suitable and to be tailored to your needs.

A whistling sound when you breathe can be due to turbulent airflow through narrowed breathing tubes in your lungs. This narrowing can be due to the presence of mucus, inflammation and swelling, co-existing asthma, or a chest infection.

This could be due to several causes such as constricting of the muscles around the breathing tubes, stiffening of the lining (pleura) around the lung, lung over-inflation as gas is trapped due to the inability to properly empty air when breathing out, prolonged coughing, a chest infection or blood clot in the lungs. Speak with your medical practitioner if this is concerning.

More energy is used for breathing in COPD. Excessive weight loss can also occur because breathlessness interferes with eating, hyperinflated lungs exert downward pressure causing a bloated gut, and medications can reduce appetite. It is important to address this symptom as it is associated with increased risk of mortality. Learn more about diet and nutrition in COPD.

Skeletal muscle dysfunction is common in COPD. This is due to the loss of muscle mass, inability of residual muscle to use oxygen efficiently, and a change in the muscle fibre type (swapping from endurance fibres to quick burst-fibres resulting in faster fatigue). Physical activity and exercise play an important role in managing COPD.

There can be many factors contributing to fatigue, other than the lung disease alone. Exercise performance, diet, other health conditions, sleep quality and flare-ups are possible contributors. Your medical practitioner will be able to assess causes and make a plan to address them with you. Consider energy conservation strategies if fatigue is significantly impacting your daily activities.

Overtime, there is an increase in blood pressure within the lungs (pulmonary hypertension) and the heart has to work harder to pump blood through the lungs. Eventually the strain on the heart results in heart failure. This can cause blood to back up and pool in the lower parts of your body due to gravity (swelling). As oxygen-carrying blood is diverted to sustain vital organs, a bluish discolouration can occur in the peripheries such as your fingertips. This sign is commonly in the advanced stage of disease.

Weakening of the pelvic floor overtime due to forces exerted by persistent coughing can result in unintentional small leaks through to complete loss of control of urine, faeces or flatus. Good continence habits and pelvic floor strengthening are effective treatments. Learn more and get help.

Sleep quality can be affected in COPD from delayed sleep onset to frequent arousals. Obstructive sleep apnoea might be an overlapping condition. If you have poor sleep quality, your GP might deem it appropriate to refer you to a sleep physician (specialist) for further investigations. Alcohol avoidance, weight management, enhancing nasal patency and cultivating good sleep habits are also useful in improving sleep. You may find more useful information on sleep related topics from the Sleep Health Foundation.