Living with a chronic lung disease like COPD means dealing with a lot of uncertainty. This includes small, everyday uncertainties (like “will my symptoms act up today?”) and broader unknowns about the long-term future of your health.
These uncertainties are amplified by the fact that COPD is progressive, which means that the disease inevitably gets worse over time. COPD patients have to live with the knowledge that their condition will worsen without knowing when or how it will happen, or what additional complications might eventually arise.
This is further complicated by the fact that COPD is, well... complicated. Every case of COPD is different, making it difficult to predict a patient's future outcomes or get an accurate timeline for the course of their disease.
What's more, COPD symptoms tend to fluctuate frequently, often without any obvious warning or explanation. This makes it difficult for many COPD patients to interpret their symptoms, which can cause a great deal of anxiety anytime those symptoms change.
That's why we created this guide to answer the the oft-asked question, “Is my COPD getting worse?” We'll start by exploring COPD progression, including how it works and what it looks like. Then we'll show you how to tell the difference between permanent COPD progression and the kinds of temporary symptom flare-ups that affect all COPD patients, even those with “stable” COPD.
Next, we'll walk you through a series of questions and real-life scenarios that can help you evaluate the progression of your own (or a loved one's) COPD. Then, we'll send you off with some practical tips to help you take a more active role in monitoring and managing your disease.
By the end of this guide, you'll know how to spot the signs of COPD progression and how to work with your doctor to get the best possible outcomes for your disease. But before we get too far ahead, let's take a moment to examine some key dynamics COPD progression, including how it happens, why it happens, and what you can (and cannot) do to slow it down.
COPD Progression: The Unfortunate Reality of Living With COPD
COPD progression is a fact of life for COPD patients, and this naturally causes a great deal of anxiety for many people with COPD. A major source of that anxiety is uncertainty about the future—the sense of not knowing when and how the disease will worsen, or how you will deal with those changes when they come.
And while it's not possible to get rid of that uncertainty entirely, knowledge can be a powerful mitigating force. The more you learn about COPD progression, the more prepared you'll be when it happens, and less scary and unfamiliar the future will seem.
In the following sections, we're going to take a closer look what COPD progression looks like and what causes COPD symptoms to get worse over time. We'll also look at some of the ways doctors and researchers predict future COPD progression, and how certain symptoms and risk factors are linked to slower or faster progression in people with the disease.
How COPD Progression is Measured: The 4 Main Stages of COPD
Doctors have a variety of ways to measure how severe a person's COPD is and, thus, how far the disease has progressed. Methods include tracking patients' symptoms, analyzing data from lung function tests, and using other data (e.g. symptoms, exacerbations, and medical imaging) to estimate the severity of the disease.
The most common method for determining COPD progression is known as “staging” or “grading,” which is a standardized technique for ranking the severity of COPD on a scale from 1-4. The most widely-used staging guidelines (known as the GOLD Criteria) allow doctors to quickly judge a person's COPD stage based primarily on the results of simple lung function tests.
In general, COPD symptoms get more severe and more numerous as you progress upward through the stages. For example, you might start out in stage 1 with some occasional breathlessness and coughing, but then acquire additional symptoms (e.g. persistent breathlessness, coughing, and fatigue) by the time you reach stage 3.
Other data can also be used to get a more in-depth picture of a patient's condition or to pinpoint specific health problems and complications. For example, doctors can often learn specifics about a patient's lung condition and function from x-ray images, CT scans, and analyzing other tissues and bodily fluids (e.g. lung fluids, sputum, and blood).
To learn more about the different stages of COPD progression, including what kinds of challenges, symptoms, and treatments to expect at each stage, check out the following guides from our Respiratory Resource Center:
- What You Need to Know About the 4 Stages of COPD
- 6 Things You Should Know if You're Diagnosed with Stage 1 COPD
- End Stage COPD: How to Plan and What to Expect
- 11 Things You Should Do After You're Diagnosed with COPD
Why Does COPD Progress?
Unfortunately, we simply don't know a lot about why COPD progresses and why it cannot be cured. For example, we don't know exactly why some people who smoke get COPD (and continue to degenerate) while others don't.
However, we do understand many of the mechanics involved in COPD progression, even if we can't always explain why they occur. These mechanics include chronic lung inflammation and the gradual accumulation of damage to tissues in the lungs.
Most of the time, COPD occurs after long-term exposure to lung irritants (like tobacco smoke) that damage sensitive lung tissues over time. In people with COPD, those damaged lung tissues never heal completely, but instead are left weaker and even more sensitive than before.
As a result, the lungs become extra susceptible to inflammation and disease, which causes even more damage and scarring in the lungs. This triggers a vicious cycle in which the lungs are perpetually inflamed and more and more tissues get damaged, making the lungs ever weaker and more sensitive with time.
Unfortunately, there's currently no way to stop or reverse this cycle, which is why COPD is a chronic, life-long, and incurable disease. Of course, that doesn't mean COPD is untreatable; there are many COPD treatments and medications that are effective at controlling COPD symptoms and even slowing down the progression of the disease.
It's important to note that COPD progression is not a smooth or linear process; it can speed up, slow down, or move in stops and starts. Some patients have faster disease progression than others, and some people stay “stable” for months or years at a time before experiencing any significant progression or worsening of their COPD.
Can You Predict COPD Progression?
There are a number of measurable factors that can help predict the likely short-term and long-term health outcomes (or prognosis) for people with COPD. For example, there are a number of risk factors that are linked to quicker disease progression, including:
- Severe COPD symptoms
- Lack of exercise
- Poor nutrition
- Frequent exacerbations
- Frequent hospital stays
- Heart disease
By analyzing these and other factors, it is possible to make educated guesses about things like life expectancy, the speed of disease progression, and how likely you are to develop certain health complications associated with COPD.
However, making these kinds of predictions is both difficult and imprecise. You would need a trained medical expert to come up with any kind of meaningful prediction about the future of your COPD, and even then it would only be an educated guess.
If you want to know more about your COPD prognosis and/or future health risks, you should ask your doctor or respiratory medicine specialist to go over your prognosis with you. An expert who's familiar with your health history and medical records should be able to explain your future health prospects and offer some insight into what your health future might be.
Can You Slow Down COPD Progression?
There has been a lot of research dedicated to figuring out how different COPD treatment methods affect patients' long-term outcomes, including whether or not they can slow down the progression of COPD. This research has identified a number of different treatments and lifestyle changes that are associated with slower progression of COPD, including:
- Quitting smoking
- Getting adequate exercise
- Maintaining a healthy weight
- Completing a pulmonary rehabilitation program
- Minimizing exposure to lung irritants (e.g. air pollution)
- Getting early treatment
- Taking COPD medications consistently and correctly
- Keeping symptoms under control
- Avoiding illnesses and exacerbations
It's important to note, however, that while all of these factors are associated with slower disease progression, it's not always clear whether or not they are directly causing progression to slow. It's difficult to tease apart the exact nature of the relationship; for example, does having well-managed COPD symptoms cause the disease to progress slower, or does having a slower-progressing disease make the symptoms easier to control?
Hopefully, future research can give us more insight into this question and provide new avenues for slowing disease progression in people with COPD. In the meantime, however, most experts agree that you can improve your COPD prognosis by doing the following things: quit smoking, stay active, get treated by a a qualified health professional, and be diligent about taking your medications and following your doctor's advice.
If you'd like to learn more about how to slow down COPD progression and improve your long-term prognosis, check out our guide: How to Take Control and Slow the Progression of Your COPD
What's Causing My Symptoms? How to Tell the Difference Between Permanent COPD Progression, Temporary Flare-Ups, and Acute Exacerbations of COPD
As we mentioned earlier, it's normal for COPD symptoms to fluctuate from day to day without any apparent reason, or to get worse for a period of months or weeks during a COPD exacerbation. This can make it hard to pinpoint the reason why your symptoms are acting up, including whether it's caused by a temporary or permanent change in your COPD.
Luckily, it is possible to determine the likely cause of an uptick in symptoms if you know what to look for. You just have to pay close attention to the nature, severity, and length of your symptoms, as well as the context in which they occur.
Minor Symptom Flare-Ups
Here we're using the term “minor symptom flare-up” to refer to the normal COPD symptom fluctuations that happen in just about everyone who has COPD. Essentially, we're talking about those days when you wake up and your symptoms are worse than usual, but then they get better within a couple days.
This can happen for all kinds of reasons—maybe the air pollution was especially bad that day or you exerted yourself too much the day before. Flare-ups can also happen for seemingly no reason at all; sometimes you just have bad COPD days.
Most of the time, flare-ups are nothing to worry about and you can get over them on your own. You might need to make some minor changes, like getting some extra rest or using your quick-relief inhaler more often, but you probably won't need any other medical intervention.
That doesn't mean you should take minor flare-ups too lightly, however; sometimes what seems like a minor flare-up can turn into a full-blown COPD exacerbation. It's best to treat flare-ups as a “watch and wait” situation: you shouldn't worry too much, but you shouldn't ignore it either in case it turns out to be something more serious down the line.
COPD exacerbations usually occur when you get sick with a respiratory illness, such as a bacterial lung infection or a simple cold or flu. This results in severe lung inflammation that causes COPD symptoms to worsen significantly for a period of time.
COPD exacerbations can last for weeks or months, and recovery usually requires extra medication or medical intervention. The increased symptoms usually go away when the exacerbation is over, though it can take a long time before they totally get back to baseline.
You can usually tell exacerbations apart from temporary symptom flare-ups because they last longer and tend to be more severe. However, exacerbation severity can vary quite a bit; some are minor and only require minimal intervention, while others are life-threateningly severe.
As a general rule of thumb, you should suspect an exacerbation if you experience worse symptoms (e.g. you feel more breathless, more fatigued, your coughing gets worse, etc.) that don't get better within a few days' time. If they get worse or persist without getting better, you should get in contact with your doctor or follow the corresponding instructions in your COPD action plan.
It's also important to not that, while COPD exacerbations in and of themselves are not a sign of COPD progression, they are linked to permanent COPD progression in a couple of different ways.
First, the frequency and severity of COPD exacerbations are often used as a measure of COPD progression, as they tend to get worse in the later stages of COPD. If you're having more frequent exacerbations, or having more severe symptoms during exacerbations, this could be a sign that your COPD is getting worse.
Exacerbations can also play a direct role in COPD progression, as severe exacerbations can cause irreversible lung damage and lung function loss. In general, the fewer exacerbations you experience, the lower your risk for the additional lung damage associated with exacerbations that, cumulatively, can result in quicker progression of COPD.
This is why preventing exacerbations is such a critical priority for doctors and patients managing COPD. It's also why it is so important to identify and treat exacerbations early, before they get to the point that they become difficult to treat and control.
Compared to minor flare-ups and exacerbations, which tend to come on quickly, COPD progression is a long-term process that tends to happen over the course of months or years. That means you can't judge COPD progression based on just a few days or weeks of symptoms; you have to think long-term, on the order of several months, at least.
So if you've only been experiencing elevated symptoms for a few days or weeks, it's likely much too early to tell if they're caused by permanent disease progression. But if the symptoms persist for months and months without any sign of getting better, it could be a sign that your COPD is getting worse.
Unlike symptoms caused by minor flare-ups and exacerbations, elevated symptoms resulting from permanent COPD progression don't ever really go away. Instead, those symptoms become part of your new baseline—part of your normal, everyday symptoms that you experience as part of the disease.
Elevated baseline symptoms aren't the only sign of COPD progression, however. There are other changes that tend to come hand-in-hand with permanent COPD decline, namely more frequent exacerbations and lung function loss.
Research has well-established that people with COPD tend to experience more severe and frequent exacerbations as the disease progresses. In fact, exacerbations are considered to be “one of the most important predictors of the progression of COPD.”
Lung function is also closely tied to COPD progression. It's the primary criteria used to grade COPD severity and measure how quickly the disease get worse over time. Generally, the quicker your lung function declines, the quicker your COPD is progressing, and the quicker your symptoms will get worse over time.
Clues that Your COPD is Getting Worse: Signs to Watch Out For
In the following sections, we're going to go through some common scenarios that people with COPD experience. Each scenario reflects a situation or circumstance that could be a red flag that your COPD is getting worse.
While none of these scenarios is decisive on its own, each addresses a specific symptom, health complication, or another known indicator of worsening COPD. We hope that, by reviewing these life-like scenarios, you'll get a better idea of what worsening COPD can look like and be better able to recognize the signs of progression in your own life.
You're Spending More Time at the Hospital
Most people with COPD will have to be admitted to the hospital at some point to get treatment for an exacerbation or another complication of COPD. However, people with mild COPD rarely need hospital treatment; it's much more common in the mid-to-late stages of the disease.
People with moderate COPD might occasionally need to be hospitalized for exacerbations, though (depending on doctors' advice) some exacerbations can be treated at home. Those with severe disease tend to be hospitalized more frequently—and have longer hospital stays—both because their exacerbations tend to be more severe, and because treatment can be complicated by the presence of other health complications.
So, if you've been hospitalized for COPD for the first time recently, or have needed hospital treatment more often than usual, it could be a sign that your COPD is getting worse. Of course, it's also possible that you just had bad luck, especially if it's an isolated incident and not an ongoing trend.
More frequent exacerbations can also be a sign that you're not getting (or keeping up with) the treatment you need to properly manage your COPD. But if you're doing everything you're supposed to, and you're still having exacerbations more frequently than before, it's a strong indication that your COPD might be getting worse.
You Can't Get Around As Well as You Used To
People with COPD often struggle with physical exertion, including walking and standing for long periods of time. Mobility problems like this can be both a cause of COPD progression as well as a consequence of worsening COPD.
For example, worsening COPD symptoms (like breathlessness and fatigue) can make it harder to exercise, causing many patients to avoid physical activity. However, lack of exercise tends to make those symptoms even worse, leading to even more mobility issues and quicker physical decline.
This can make it difficult to tell whether mobility problems in COPD patients are simply a symptom of COPD progression or if it's the lack of physical activity that's causing symptoms to get worse. Regardless of the cause, however, research shows that muscle weakness and reduced mobility are major predictors of negative future outcomes and health complications (including an increased risk for exacerbations, hospitalization, and death) in people with COPD.
Unfortunately, many people with COPD get caught in a vicious cycle of exercise avoidance, which makes it harder and harder to be active the longer it goes on. If you'd like some tips on how to get out of that cycle, or how to exercise safely even when you feel breathless, check out the following guides:
- How to Effectively Exercise at Home with COPD
- How to Improve Your Exercise Tolerance and Improve Your Quality of Life with COPD
- How Portable Oxygen Therapy Can Help You Live a More Active Life with COPD
You've Been Diagnosed with Additional COPD Complications
If you've recently been diagnosed a new chronic health condition—especially hypertension, heart disease, hypoxemia, or dementia—it could be a sign that your COPD is getting worse. As your COPD gets worse, so does your lung function, and poor lung function can cause problems in many different parts of the body, not just the lungs.
For example, when your lung function gets bad enough, your lungs can't absorb enough oxygen fast enough to keep up with the body's needs on their own. This forces the heart to compensate by pumping harder and faster, which, over time, can weaken both your heart muscle and your blood vessels, leading to hypertension and heart disease.
Eventually, poor lung function can result in chronically low blood oxygen levels, a condition known as chronic hypoxemia. This, in turn, can reduce your brain's supply of oxygen, leading to an increased risk of dementia and cognitive decline.
Of course, it's possible to get hypertension and heart disease for other reasons that aren't necessarily related to your COPD. If you're ever unsure, your doctor can help you understand how your different health conditions are (or aren't) related, and how they might affect your COPD.
It's important to keep all of your doctors in the loop whenever anything about your health changes, even if those changes don't appear to be directly related to your COPD. That way, they can ensure that your treatment plans are properly coordinated and optimized to manage all of your health conditions, including your COPD.
Your COPD Treatment Plan Has Changed
A good COPD treatment plan is designed to be versatile in order to manage the normal symptom fluctuations that occur in people with COPD. This way, doctors don't have to change their patients' whole treatment plans every time they experience a minor symptom flare-up or exacerbation.
This also means that a change in your treatment plan is a sign that something about your COPD has changed, and that the change isn't going away any time soon. So if you've been experiencing new or worsened symptoms for awhile, and your doctor has added additional medications or treatments to your COPD treatment plan, it's likely that it's because your COPD has gotten worse.
This is especially true if you've been prescribed supplemental oxygen therapy, which is usually only necessary in the later stages of COPD. Generally, having to start using oxygen means that your lungs have declined past a certain threshold where they can no longer function well enough to supply your body with the oxygen it needs on their own.
Ideally, your doctor will explain treatment changes to you when they happen so you're not in the dark about why it happened or what those changes mean. But if you are ever unsure about anything related to your treatment plan or your symptoms, don't be afraid to discuss it with your doctor, even if you have to bring it up on your own.
What Can You Do to Better Prepare and Respond to Worsening COPD Symptoms?
Whether your COPD is stable for now or it's actively getting worse, it's always a good idea to stay on top of your condition. That means monitoring your symptoms and working with your doctor to identify and respond to changes quickly when they occur.
Taking an active role in your COPD management makes it easier to prepare for the challenges and changes to come in the future. The better prepared you are, the easier those changes will be to cope with, and the more opportunities you will have to shape what your future will be.
No matter your COPD stage or what condition you're currently in, you will always have opportunities to maintain some measure of control over your health. Taking the right steps now can give you the change to improve your quality of life (both now and in the future) and to avoid complications that could worsen your COPD.
The earlier you take an active role in managing and monitoring your disease, the more opportunities you will have to improve it. So without any further ado, let's take a look at some simple steps you can take to regain some control over your health and lay the groundwork for a better future with COPD.
Track Your COPD Symptoms
Monitoring your symptoms means paying close attention to how you feel every day so you are familiar with what you “baseline” symptoms are. It also means keeping track of how your symptoms change on both a short-term (day-to-day) and long-term (month-to-month and year-to-year) basis.
This not only helps you and your doctor choose the best treatments for your symptoms, but also serves as an early warning system when something goes wrong. For example, tracking your daily symptoms can alert you to signs of an oncoming COPD exacerbation, giving you a chance to get early treatment that could make the exacerbation less severe.
Symptom tracking is also important for everyday COPD management, as many home COPD treatment plans (aka COPD action plans) include different sets of instructions to follow based on your symptoms. You have to pay close attention to how your feeling each day in order to use those guidelines properly and know when you need to make adjustments to your medication and/or activity routine.
So what exactly does tracking your COPD symptoms actually look like? It can be as simple as keeping a daily log of your major symptoms or as complex as tracking multiple symptom categories in a spreadsheet or mobile app. Exactly how you monitor your symptoms doesn't really matter as long as you find a method that works for you.
Look for Patterns & Changes
Another major benefit of tracking your COPD symptoms is that it gives you the opportunity to look back on the data you've collected to identify patterns and changes. This can help you learn how to interpret your own symptoms better and identify how your body responds to different environments, activities, and other variables in your life.
For example, you could gain insight from your symptom logs leading up to an exacerbation that could help you catch the next exacerbation earlier than before. You might also be able to pinpoint COPD triggers by looking for similarities between days when your symptoms get worse.
Paying attention to these patterns can also alert you to problems that you might otherwise not notice, such as a gradual worsening of certain symptoms over time. These broader trends in your health can help your doctor better tailor your COPD treatments and recognize additional COPD complications if and when they occur.
Monitoring your symptoms can help you notice positive changes too, such as improvements in your symptoms after starting a new medication or exercise routine. When you can see the positive impact of these health interventions, it's easier to muster the motivation to keep up with the healthy habits, medications, and other treatments that help you manage your COPD.
Keep Your Doctor in the Loop
While you're tracking your symptoms, it's important to to keep your eye out for things your doctor might need to know. That could include things like a sudden increase in your symptoms or the appearance of a new symptom you haven't experienced before.
Catching these kinds of things early allows you to get prompt treatment, which leads to better health outcomes long term. It can help you avoid complications like severe exacerbations, for example, which can result in permanent lung damage and lung function decline.
Or course, it's not always easy to know when your symptoms are serious enough to need special attention or treatment; but the better you know and track your symptoms, the easier it will be to tell when something is really wrong.
Of course, if you have any doubts or concerns, you can always schedule an appointment or call your doctor up for advice. You should also make sure that you know how to recognize the signs of a medical emergency so you can seek emergency medical care right away.
Part of having COPD is living with symptoms that are constantly in flux. This can be a tough burden to live with, especially when you have the added pressure of knowing that those symptoms will eventually get even worse.
But even though certain things about your health might be out of your control, it's important to remember that there are still plenty of things which you do have control over. Actions you take now can influence your odds for the future, and potentially even slow down the progression of your COPD.
When you make the effort to live a healthy lifestyle, monitor your symptoms, and manage your COPD properly at home, it can have long-lasting positive effects on your health. And when you how what warning signs to look out for, you're much more likely to get prompt, effective treatment whenever your symptoms change.