COPD symptoms and management guide

September 12, 2025

Providence Health Team

[9 MIN READ]

COPD makes breathing progressively harder. This chronic lung disease traps air in the lungs, causing shortness of breath, persistent cough and fatigue.
Smoking and environmental exposures are major risk factors. Genetics and occupational hazards can also increase your likelihood of developing COPD.
A pulmonology expert at Providence explains how the right care can help slow progression and improve quality of life. Treatments include medications, oxygen therapy, lifestyle changes, breathing exercises and pulmonary rehabilitation.

Breathing easier: Recognizing and managing COPD

Breathing is something many of us don’t even think about — until it suddenly becomes difficult. For the millions of people living with chronic obstructive pulmonary disease (COPD), even everyday activities like walking or climbing stairs can trigger shortness of breath. That feeling of being trapped in your lungs can be overwhelming and frustrating.

COPD develops over time and often goes unnoticed in its early stages. Identifying the symptoms and understanding how the disease affects your lungs can make a big difference in managing it effectively.

We spoke with Jiten Patel, M.D., a pulmonologist at Providence Pulmonary – South, about recognizing COPD, getting treatment and living well with a diagnosis. Here’s what he shared.

What is COPD?

COPD, or chronic obstructive pulmonary disease, is a progressive condition that damages the lungs and airways, making it hard to breathe. We call it “obstructive” because the challenge isn’t getting air in — it’s getting air out.

Normally, inhaling feels active and easy, while exhaling happens almost automatically, thanks to the lungs’ natural elasticity. With COPD, though, that elastic push gets weaker.

Dr. Patel explains it like this: “COPD makes you lose elasticity in your lungs. That causes air to become trapped or stacked because you can’t fully exhale before taking the next breath. It’s like your lungs are holding onto air they can’t let go of.”

Inside your lungs, airways branch out like an upside-down tree, starting with a large trunk that splits into smaller branches. These branches are tubes that carry air deep into your lungs. In COPD, inflammation, thick mucus and enlarged glands cause these tubes to narrow and tighten.

Types of COPD

There are two main types of COPD: chronic bronchitis and emphysema. Many people with COPD have features of both.

In chronic bronchitis, inflammation and excess mucus make it harder for air to flow. You might have a persistent cough or feel short of breath, even during simple tasks.

Emphysema affects the tiny air sacs in the lungs, called alveoli, where oxygen and carbon dioxide exchange. In this type, damage to the alveoli reduces lung elasticity, traps air and makes exhaling difficult.

Recognizing the signs and symptoms of COPD

COPD can show up in different ways, and sometimes it sneaks in quietly. In the early stages, many people don’t notice any symptoms at all. That’s why it’s important to know what to watch for — both the common signs and the more serious ones.

Early warning signs

One of the first signs of COPD is shortness of breath. “At first, this breathlessness might only happen when you’re walking or exercising, but over time, it can become more frequent — even at rest,” Dr. Patel says.

Other common COPD symptoms include:

A chronic cough that may or may not bring up mucus
Tightness in the chest
Unexplainable fatigue
Upper airway issues, like:
- Postnasal drip
- Runny nose
- Sinus congestion

Dr. Patel points out that sometimes the most common symptom is none at all. He finds that many patients don’t realize how COPD is affecting them until asked about their physical activity levels.

When to be concerned about shortness of breath

Shortness of breath is one of the main symptoms of COPD, but it’s not always an emergency. The key is to notice when it’s getting worse, or when it feels different than usual. Dr. Patel stresses that certain changes can signal when a flare-up needs urgent medical care, including:

Severe breathlessness: You can’t finish a sentence without gasping for air.
Shortness of breath at rest: You feel breathless even while sitting or resting.
Cough or mucus changes: You notice a sudden change in your cough, like more mucus than usual or coughing up blood.
Bluish lips or fingertips: A bluish tinge (cyanosis) may signal dangerously low oxygen levels.
Swelling in your feet, ankles or fingers
Unexplained weight loss
Rescue inhaler failure: Two puffs of quick-relief medicine don’t ease your breathing.

If you notice any of these warning signs, seek emergency care right away. For ongoing COPD management or concerns about your breathing, schedule an appointment with a Providence provider. We’ll help you get the right diagnosis and treatment plan.

The difference between COPD and asthma

Asthma and COPD can look similar from the outside. Both make it harder to breathe out, and both can leave you feeling winded. But the way they develop and behave is different.

Asthma is usually an acute (short-term) allergic inflammation, triggered by allergens or irritants. With the right treatment, symptoms can significantly improve or disappear.

“COPD, on the other hand, is generally irreversible,” Dr. Patel says. “Once lung damage happens, we can’t bring your function back to what it was before. But we can slow the progression and help you protect the breathing capacity you still have.”

COPD can also develop from a wider range of causes, such as smoking and long-term environmental factors. And it can come with other complications, like heart disease, osteoporosis, sleep apnea and depression.

Risk factors and causes of COPD

COPD doesn’t develop overnight. Instead, it builds slowly over time, often without obvious warning, until symptoms start to interfere with daily life. The causes are different for everyone, but there are well-known factors that can raise your risk.

Smoking and COPD

In the United States, smoking is the number one cause of COPD. Doctors measure the risk in “pack-years,” which is the number of cigarette packs smoked per day multiplied by the number of years smoked.

“We normally define COPD in patients who are 40 and above, with a 20 pack-year history and lung function testing showing obstruction,” Dr. Patel explains. “The earlier someone starts smoking, the greater their lifetime risk. We all lose a little bit of lung function each year with age, but that loss is far greater in active smokers.”

Environmental and occupational factors

Another leading cause of COPD is exposure to biomass fuels, including smoke from burning wood, charcoal or other materials for cooking and heating. This is especially common in areas without clean indoor air quality technology.

Dr. Patel also stresses the importance of looking at occupational risks when diagnosing patients. Certain jobs expose people to lung irritants that can trigger microscopic inflammation in the airways, increase mucus production and narrow breathing passages. Common occupational irritants include:

Beryllium
Dusts from construction, mining or manufacturing
Farming chemicals, like herbicides and pesticides
Heavy metals
Nuclear waste

Genetic factors

Sometimes the cause is in your genes. Alpha-1 antitrypsin (AAT) deficiency is an inherited condition that can make you more susceptible to developing COPD. AAT is a protein your liver produces to help protect your lungs. When your body doesn’t have enough AAT, your lungs become more vulnerable to harm from smoking, air pollution and other risks.

Getting diagnosed: Tests and stages

Diagnosing COPD involves looking closely at your symptoms, medical history and test results to get a clear picture of what’s going on with your lungs. Dr. Patel guides you through what you might experience during the process.

“The first step is a review of your medical history and a physical exam,” he says. “You’ll discuss your breathing, symptoms you’re experiencing and how these are impacting your daily activities. Your health care provider will also want to know about your smoking history and any environmental factors.”

During the physical exam, what your doctor notices can differ depending on your COPD stage:

If it’s early, your exam might seem pretty normal. You might have subtle signs like a prolonged wheeze or a slower breath out.
If it’s more advanced, your doctor might notice your lungs look overinflated, your chest appears barrel-shaped, or your breath sounds wheezy or crackly. An X-ray might show changes like a depressed diaphragm.
In later stages, called end-stage COPD, you might find yourself leaning forward, using your neck and shoulder muscles to breathe or pursing your lips to help with airflow.

Your doctor may order a spirometry test, which measures how well you can blow air out of your lungs. You’ll be asked to take a deep breath and then blow into a device. This test helps providers see if your lungs have trouble pushing air out. It’s also useful for ruling out other causes of your symptoms.

If you receive a COPD diagnosis, your pulmonologist will determine how severe your disease is to guide your treatment. Dr. Patel uses guidelines like the GOLD criteria from the Global Initiative for Chronic Obstructive Lung Disease, which groups patients based on symptoms and history:

Mild cases involve few symptoms and a smoking history
Moderate cases may include more symptoms or a recent exacerbation
Severe cases involve several exacerbations

Treatment options for COPD

“COPD treatment is all about managing the whole picture, including lifestyle, medications, therapies and ongoing care,” Dr. Patel says.

Medications play a central role. Long-acting inhalers help open up airways and ease breathing. Sometimes, your provider will combine your inhaler with steroids to reduce inflammation. Nebulizers can deliver medication as a fine mist, which some find easier to use. Rescue inhalers provide fast relief during flare-ups.

“Not every treatment fits every patient,” Dr. Patel notes. “It’s about finding the right combination of medications to reduce symptoms and prevent flare-ups.”

If your disease is more advanced, oxygen therapy may be a good option. “Even when oxygen levels look normal on tests, some patients may still feel breathless. Supplemental oxygen can help with that,” Dr. Patel explains.

Advanced procedures for severe emphysema

For some people with severe emphysema, there are specialized procedures that can help improve breathing and quality of life.

One option is lung volume reduction surgery (LVRS). Your doctor may consider it if you’ve quit smoking for at least six months and are still experiencing significant breathing problems. The surgery removes the most damaged areas of your lungs to reduce overinflation and improve diaphragm and chest wall function.

A less invasive option is bronchoscopic lung volume reduction (bLVR). Your doctor uses a small device called an endobronchial valve (EBV) to block airflow into the most damaged parts of your lungs. There are two types of valves:

Zephyr EBV: Works like a duckbill to let air out
Spiration EBV: Works like an umbrella to expand during inhalation and contract during exhalation

Both valves allow air and mucus to leave the affected areas but prevent new air from entering, which helps the damaged parts of the lungs collapse.

“The main goal of these procedures is to reduce the work it takes to breathe,” Dr. Patel says. “We track progress in your shortness of breath and ability to perform everyday tasks to see how well the treatment is working.”

Living well with COPD

Living well with COPD means taking steps to manage symptoms, improve comfort and slow your disease’s impact. Dr. Patel offers some practical strategies.

Breathing techniques and exercises

Dr. Patel is a strong advocate for pulmonary rehabilitation. These programs teach breathing techniques, provide supervised exercise and help patients set realistic goals.

“We aren’t just focused on treating the lungs. We also address the fear and anxiety that come with struggling to breathe,” he says.

You can also find several breathing exercises online, like these from the American Lung Association.

Lifestyle changes

Dr. Patel says the single most important step anyone with COPD can take is to stop smoking. “It won’t restore your lung function to what it was, but it can slow your decline to almost that of a non-smoker. It’s never too late to quit,” he adds.

Beyond the lungs, quitting smoking has major benefits for your overall health. Cardiovascular risks drop within a year, and after ten years, the risk of lung cancer nearly reaches that of someone who never smoked, though past exposure still carries some risk.

It’s also important to avoid harmful exposures as much as possible. These include environmental pollutants, workplace dust, biomass fuels and secondhand smoke.

Above all, Dr. Patel encourages patients to take ownership of their health and stay engaged in care. That means taking prescribed medications, following treatment plans, being open to rehabilitation therapy and returning to activities they once enjoyed.

Nutrition and exercise

Nutrition is important for managing COPD, especially in its later stages. Because breathing with COPD requires more effort, your body burns more energy. Over time, this can lead to malnutrition and muscle loss if you’re not keeping up with your daily calories. While it’s always important to eat a balanced diet, Dr. Patel recommends protein-rich foods to help build strength.

“Using the right inhaler and oxygen therapy matters, but staying active and well-nourished is just as essential,” he says. “I encourage patients to gradually ease back into activities that fit their abilities. Even if you get breathless or need supplemental oxygen, regular movement helps keep muscles working and preserves mobility. Just start small.”

Managing COPD flare-ups

A COPD flare-up, or exacerbation, occurs when breathing suddenly worsens. You might experience breathlessness, coughing, more mucus production, fatigue or low oxygen levels. Each time you experience one, your lung function can decline.

“We try to focus on reducing risk factors and starting treatment early to prevent flare-ups from happening in the first place,” Dr. Patel says. “Because after one happens, the likelihood of another within 90 days is high.”

Keep your rescue inhaler on hand for quick relief if flare-ups occur. If symptoms don’t improve after taking two puffs, seek urgent care or go to the ER right away.

The pulmonology team at Providence is always ready to help. We’ll schedule regular check-ins to stay on top of your COPD and prevent future flare-ups.

Contributing caregiver

Jiten Patel, M.D., is a pulmonologist at Providence Pulmonary – South in Spokane, Washington.

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