Symptoms and Impact

The characteristic chronic symptoms of chronic obstructive pulmonary disease (COPD) are dyspnoea, cough and sputum production. In addition to these symptoms, patients may develop a number of extra pulmonary symptoms, such as fatigue, anorexia and weight loss.1  


Dyspnoea, or breathlessness, is the hallmark symptom of COPD, and is the most frequent reason that patients seek medical attention.1 Dyspnoea in COPD is typically persistent and progressive. Greater impairment in pulmonary function is associated with poorer exercise performance.2 During the early stages of disease, dyspnoea is only noticed on unusual effort (e.g. running up a flight of stairs) and may be avoided by behavioural changes. As lung function deteriorates, dyspnoea increasingly accompanies normal everyday activities, and eventually will be present even at rest.

Patients report that shortness of breath is the most bothersome symptom and is the reason most seek medical attention.1,3

Dyspnoea and reduced physical activity

COPD also impairs the capacity of patients to undertake physical activity even in those with mild COPD.4 Reduced levels of physical activity may be associated with an increased risk of morbidity, beyond that directly attributable to COPD.5  

Shortness of breath and reduced exercise endurance are seen in patients with all severities of COPD.6

Exertional dyspnoea often causes patients with COPD to unconsciously reduce their activities of daily living to reduce the intensity of their distress. This leads to deconditioning which, in turn, further increases dyspnoea7 (Figure 1).

Patients restrict activities to avoid shortness of breath.

Figure 1. Patients restrict activities to avoid shortness of breath.7,8,9 Figure adapted from Reardon, 2006.


Often the first symptom to develop, chronic cough is frequently discounted by the patient as an expected consequence of smoking or environmental exposures.1 Initially, the cough may be intermittent, but later is present every day. Chronic cough associated with COPD can be productive or unproductive. Notably, some patients can develop considerable airflow limitation without the presence of a cough.

Sputum production

Excess sputum production is a key symptom of COPD, and patients frequently raise small quantities of viscous sputum after coughing bouts.1 Sputum production is often difficult to evaluate because many patients swallow rather than expectorate it.

COPD is a progressive disease of the respiratory system that results in permanent decline in lung function. Accordingly, the classic symptoms of COPD – dyspnoea, cough and sputum production – increase over the course of the disease.