COPD Symptoms, Signs & Stages

What are the symptoms and stages of COPD?

copd symptoms, copd stages, copd signs, living with copd, chronic obstructive pulmonary disease, copd treatment, copd treatmentsChronic obstructive pulmonary disease (COPD) affects your lungs, making it difficult to breathe. At the beginning, early signs of COPD may be mild, and may even go unnoticed. But over time, COPD symptoms tend to get worse.[1]

COPD symptoms are slow to develop and vary depending on the stage of the disease. No two people will experience the exact same symptoms, but everyone with COPD will eventually notice that it is more difficult to participate in their everyday activities. As COPD stages progress, you may notice daily activities become more difficult.

To measure the impact of COPD and assess which stage you are experiencing, your doctor may give you a COPD assessment test to help diagnose and manage your unique symptoms. The COPD test involves breathing in and out of a machine called a spirometer. Your doctor then compares the results to what is expected from a person with healthy lungs, and measures the results according to various stages.[2]

Know Your COPD Symptoms

If you have symptoms that you suspect could be signs of COPD, it is helpful to know what each symptom can look and feel like. The following COPD symptoms are common with COPD of all stages, but should be shared with your doctor if they are new.

As COPD progresses, additional symptoms might arise. The above COPD symptoms will occur more frequently and with more severity over time, but as COPD advances they become more serious and can be sudden. Knowing the symptoms of advanced COPD is essential, as they can be indicators of progression in your COPD or signs of COPD exacerbations. All these symptoms should be reported to your doctor.

  • Chronic and persistent cough: Coughs are notorious for lasting a long time, but a chronic and persistent cough is different. This type of cough lasts for two months or longer, often interrupting your sleep and leaving you feeling exhausted. A chronic cough can also cause lightheadedness, sore ribs and vomiting. Keep in mind that you may not experience any other COPD symptoms but a long-lasting cough.[3]
  • Wheezing: Wheezing is an audible high-pitched whistling that occurs when you breathe in or out. Wheezing is a sign that your breathing is obstructed, either because of excess mucus in the airways or as a result of the muscles around your airways tightening and causing constriction. Take wheezing seriously, as it is a sign that your airways are partially blocked.[3]
  • Shortness of breath: Shortness of breath is the sensation of not being able to get enough air. Shortness of breath can include a tightness in the chest, difficulty breathing, a hunger for air, a feeling of suffocating and intense anxiety. Often, COPD patients first experience shortness of breath while participating in regular activities like climbing stairs. Feeling short of breath with any amount of regularity is a concern.[3]
  • Fatigue: Fatigue is one of the easily ignored COPD symptoms, as many people may not take it seriously. However, feeling regularly or chronically fatigued is a sign that your blood, body and muscles are not getting the oxygen they need. Take note if you feel fatigued more than usual, or if you feel fatigued during or after normal activities, like doing laundry or climbing a flight of stairs.[3]
  • Frequent respiratory infections: COPD is the result of lung damage, which makes it difficult for your lungs to properly clear out irritants and mucus. This can make people more prone to bacterial and viral infections in their respiratory systems. People with COPD also have compromised immune systems, making them more susceptible to respiratory illnesses and infections.[3]
  • Morning headaches: If you wake up with headaches in the morning, it could be a sign that your body is not getting sufficient oxygen while you sleep, or that your body is not getting rid of carbon dioxide the way it should. If you repeatedly experience morning headaches for any significant period of time, you may need oxygen therapy while you sleep or, if you already use oxygen therapy, you may need to adjust your dosage.[3]
  • Swollen ankles, feet and lower legs: Swelling in the lower extremities indicates that your heart is having to work harder to pump blood to your damaged lungs. As a result, you do not receive necessary blood flow to your liver and kidneys, which help remove excess fluids from the body, and the fluid begins to collect and build up in your ankles, feet and legs.[3]
  • Unexplained weight loss: If you lose weight without trying or without any changes in your diet or exercise routine, it could indicate that your body is having to work harder than usual. For people with COPD, the body has to use more energy to breathe and to pump blood, so they may find that they lose weight unexpectedly as the disease progresses.[3]
  • Chest pressure or tightness: Chest tightness is described a number of different ways. It may feel like your chest is being crushed or squeezed, like there is a tightening band around your chest, like your chest is rigid and stiff, like there is something sitting on your chest or like there is pressure on your lungs stopping you from getting a full breath. Many people also experience shortness of breath at the same time.[4]
  • Mucus changes: If you notice that you suddenly produce more mucus and phlegm than normal when you cough or clear your throat, or if your mucus is suddenly a different color (including yellow, green, brown or red), these are signs that your body is fighting infection. A significant change in the quantity or quality (i.e. color, texture or consistency) of your mucus should be checked out. Red or dark brown mucus is a particular concern, as it indicates blood somewhere within your respiratory system.[5]


COPD Symptoms by Stage

COPD is a progressive disease, so your symptoms will get more severe with each new stage. As such, it is helpful to know what to expect at each stage so you can be prepared for what lies ahead. With proper COPD treatment, you can slow the progression of your disease, so communicate with your doctor about any new symptoms so you can treat them correctly.

Stage One 

Even in the beginning, mild COPD may present obvious symptoms and signs of COPD. People often dismiss a cough or fatigue as a side effect of smoking or advancing age. In the early stage of the disease, your lungs are still functioning at or above 80% of normal lung capacity.[1]

Stage Two 

As the disease advances, the symptoms of COPD become more of an issue. Lungs are functioning between 50 and 80% of normal lung capacity. Signs of COPD at this stage usually involve a chronic cough. Coughing is the body’s way of naturally removing mucus from the lungs, but with COPD the urge to cough becomes more persistent. It may be worse in the morning, during exercise or when smoking. You may also wheeze, producing a whistling sound when you breathe as air is forced through obstructions in your airways.

Many people also experience shortness of breath during second stage COPD as airways become inflamed and constricted. This COPD symptom makes it hard to breathe normally, especially when you are physically active. Even small tasks like bathing or getting dressed in the morning can cause shortness of breath. As a result, oxygen levels in your blood and muscles drop, increasing fatigue. In addition, you may feel tired because your lungs are working overtime to bring in more oxygen and release carbon dioxide.[1]

Stage Three 

At the third stage, your lungs are only functioning at between 30 and 50% of their normal capacity. More severe COPD signs and symptoms include feeling more fatigued and short of breath, and you may suffer frequent exacerbations. Exacerbations are flare-ups where COPD symptoms worsen and last longer, in some cases leading to hospitalization. COPD exacerbations can be caused by infections or air pollution.[1]

Frequent respiratory infections are common with COPD sufferers because your lungs cannot clear themselves of irritants, bacteria and viruses. Many people with stage three COPD battle frequent bouts of bronchitis or pneumonia as their COPD symptoms progress.[3]

Stage Four/End-Stage 

The fourth stage of COPD is often referred to as “end stage.” While that sounds daunting, you can live with stage four COPD for years with proper care and a COPD treatment program prescribed by your doctor. Today’s medical and technological advancements can enhance quality of life while living with COPD symptoms.[1]

At stage four, your lungs are functioning at less than 30% of their normal capacity. This stage presents the worst signs and symptoms of COPD, with COPD symptoms occurring even when you’re resting. People with end stage COPD may lose weight rapidly as the body uses extra energy and calories to bring in the oxygen it needs. Advanced COPD symptoms include morning headaches due to heightened levels of carbon dioxide in the blood and swollen feet due to the higher levels of stress placed on the heart.[3]

Some symptoms of COPD are more severe and may require emergency medical attention if they last longer or become worse than usual. If your lips or fingernails turn blue, or it becomes difficult to speak or breathe for long periods of time, it could be a sign that the blood contains extremely low levels of oxygen. In addition, if you feel overly confused or have a rapid heartbeat, talk to your doctor as quickly as possible. The information presented here should give you a better understanding of different COPD stages.[6]

How Inogen Can Help with COPD

Even in its early stages, COPD signs and symptoms make it difficult to take part in daily activities. As your COPD stages progress, it becomes harder and harder to live normally, but Inogen can help. The Inogen One’s portability makes it an excellent solution for helping to treat the breathing difficulties associated with COPD. As fatigue begins to set in with lower blood oxygen levels, oxygen therapy helps improve blood oxygen levels, which helps decrease fatigue, breathlessness and the anxiety associated with breathing difficulty. With oxygen therapy, patients may also experience improved sleep, alertness and mood.[7]

At Inogen, our purpose is improving lives through respiratory therapy. Our compact, lightweight and FAA approved portable oxygen concentrators provide medical grade oxygen while freeing you from carrying heavy tanks and managing refills. With the Inogen One System, designed for active patients who enjoy travel,  you can get the oxygen therapy you need, without being tethered to your tank.

No matter which of the COPD stages you are experiencing, your COPD symptoms and treatment don’t have to hold you back from your life. Inogen can help  by providing medical grade oxygen at home or away, all day, every day. (when connected to an AC or battery power source). Indicated for use in a home, an institution, vehicles and various mobile environments, the Inogen One is designed for your on-the-go lifestyle. Even if you’re living with end stage COPD, you could prolong your life by treating severely low blood oxygen levels with long-term oxygen therapy for at least 15 hours per day. [8] With this level of oxygen therapy, the portability of the Inogen One System is especially beneficial.

Inogen One portable oxygen concentrators can provide you with peace of mind when outside their home and away from their stationary concentrator. Make an appointment with your doctor to find out more about how our oxygen concentrator can help you.

Frequently Asked Questions About COPD

What are the 4 stages of COPD?

The four stages of COPD are based on the results of a few different diagnostic tests, as well as your symptoms and risk of exacerbations. Your doctor will decide which stage your COPD falls into. 

  • Stage 1: Mild COPD with few or no symptoms and low risk. 

  • Stage 2: Moderate COPD with some symptoms, but still low risk. 

  • Stage 3: Severe COPD with significant symptoms and a high risk of exacerbations. 

  • Stage 4: Very Severe COPD with significant symptoms that impact your quality of life and a high risk of exacerbations, heart failure or lung failure; is also referred to as end-stage COPD.[1] 

What are the early warning signs of COPD?

The early warning signs of COPD are usually an ongoing cough, excess mucus and phlegm with unusual color, fatigue, fluid retention, shortness of breath, tightness in the chest, trouble sleeping and waking up with a headache. Very early on, patients may not notice any symptoms. However, if you have any of these symptoms, and particularly if they are worsening with time, see your doctor for diagnostic tests to see if you may have COPD.[2]

How to know what stage of COPD you have?

Your doctor will use a few different measurements to determine what stage of COPD you have. First, your doctor will measure your forced expiratory volume in one second (FEV1). This measurement helps doctors place your COPD into the correct stage, along with the consideration of your symptoms. Doctors may also administer a 6-minute walk test, plethysmography and spirometry, which may all be part of the BODE index to measure your COPD stage. The BODE index measures your BMI, airway obstruction, dyspnea and exercise tolerance, and your index score can roughly predict mortality.[9] However, keep in mind that your BODE index, test results and COPD stage only give you an idea about how you can expect to live with your COPD. With early detection and treatment, many people live long, active lives with COPD.

What are the last stages of COPD symptoms?

The final stage of COPD, also known as stage 4 and end-stage COPD, is the stage at which your quality of life is severely impaired. At this stage, a COPD exacerbation can be life threatening. As with all cases of COPD, symptoms can vary significantly at this stage. Some people are extremely ill by the time they get to stage 4, while others are still able to function with some limitations. During end-stage COPD, symptoms worsen and can become uncomfortable. Those symptoms can include: anxiety, barrel chest, confusion, cough, depression, dyspnea (difficult and labored breathing), lung crackles, muscle deterioration, pain, weight loss or wheezing. Symptoms should be managed with medical assistance to keep patients comfortable. Many patients and families seek palliative or hospice care at this point to ensure that end-of-life care is in place.[1]

When should you go to the hospital for COPD?

If you or a loved one has COPD, it is important to know when to seek medical attention. It can be hard to determine when to go to the hospital versus when to make an appointment with your doctor, so it is helpful to have a list of symptoms that require immediate medical attention. If someone with COPD has any of the following symptoms, call 911 right away as these can be symptoms of a life-threatening condition:[10]

  • Blue fingers or lips
  • Chest pain 
  • Confusion or sudden forgetfulness
  • Coughing up more than a teaspoon of blood
  • Difficulty waking up
  • Extreme fatigue
  • Extreme weakness
  • Increased need to use breakthrough medications
  • Severe or sudden shortness of breath

The following symptoms indicate that someone with COPD needs medical attention soon. However, if the symptoms seem extreme or there is any doubt at all, it is better to be safe and call 911 or head to the ER, particularly in the later stages of COPD. Otherwise, see a doctor as soon as possible if you have these symptoms:

  • Anxiety or restlessness
  • Coughing up any blood at all
  • Deepening or more frequent cough
  • Fever of 101 or over
  • Gaining weight quickly (more than 2 pounds in a day or 5 pounds in a week)
  • Inability to walk normally or take the stairs as usual
  • Increased need for breathing treatments
  • Increased fatigue
  • Increased sputum production or colorful sputum
  • Increased weakness
  • Increased wheezing
  • Increased swelling in the legs
  • Need to elevate head more than normal to sleep
  • Symptoms of the flu like fever, body aches and sore throat
  • Waking up with headaches
  • Worsening shortness of breath or shortness of breath upon waking


  1. COPD Stages and the Gold Criteria: 4 Stages Explained (
  2. Early signs and symptoms of COPD and when to see a doctor (
  3. COPD Symptoms: Cough, Shortness of Breath, Exacerbations, and More (
  4. What Causes COPD Chest Tightness and How Can I Treat It?
  5. 4 Early Symptoms of COPD (
  6. End-Stage COPD: Symptoms, Causes, and Coping (
  7. Amer Lung Assn Supplemental Oxygen_Updated 2013.

Additional Sources

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