Common COPD Complications and How To Manage Them

Tablet lying on a table with the words "chronic obstructive pulmonary disease (COPD)" on the screen.

In both developed and undeveloped countries around the world, it is estimated that 9-10% of people are affected by Chronic Obstructive Pulmonary Disease (COPD). Experts have made a prediction that by 2020, it will be the third leading cause of death in the world as the population ages and people continue to smoke. More than 12 million people have been diagnosed with COPD in the United States alone and it is the third leading cause of death claiming more than 120,000 American lives each year.

COPD is an umbrella term used to describe progressive lung diseases including chronic bronchitisemphysema, refractory asthma and some forms of bronchiectasis. It is mainly characterized by shortness of breath. In its initial stages, COPD may show no symptoms or have very mild symptoms but as the disease progresses, the symptoms usually become more severe.




Physicians have traditionally measured the severity of COPD by the amount of air a person can forcibly exhale in one second (FEV1). The amount of air usually decreases as COPD becomes worse. Just the same, COPD affects other systems and body parts, which helps provide clues about the severity of the disease. A lot of physicians are now using the BODE index to categorize COPD and predict outcome. BODE is short for body-mass index, degree of airflow obstruction, dyspnea (breathlessness), and exercise capacity as measured in a 6-minute walk test.

You are probably familiar with COPD classic symptoms which include;

  • Frequent respiratory infections.
  • Lack of energy.
  • Chronic cough with production of a lot of mucus.
  • Experiencing shortness of breath, especially with physical activity.
  • Chest tightness.
  • Wheezing or hearing a whistling sound when you breathe.
  • Blueness of the lips or fingernail beds.

You however may not be aware of the potential common complications associated with COPD and how you can limit them. Below is a list of 6 complications that you may face with COPD. 


1. Cor Pulmonale 

Computer generated image of the heart and lungs.

This refers to a failure of the right side of the heart. It is a condition in which the right side of the heart swells up (lower extremity edema) and cannot pump blood properly. COPD makes the heart work harder, especially on the right side which pumps blood into the lungs. Due to poor gas exchange in COPD, there are reduced amounts of oxygen in the blood causing blood vessels to constrict. Many of the capillaries around the alveoli are destroyed in the disease process making the heart work even harder for blood to be forced through fewer constricted blood vessels. Because of all this effort, the right ventricle swells up, the walls of the heart become thicker, and the chamber over time loses its ability to contract efficiently.


Symptoms of cor pulmonale include fainting spells and discomfort in the front of the chest. To control your symptoms your doctor may recommend a low-salt diet, medication or supplemental oxygen. If you are an active cigarette smoker, you should plan to quit. You should also engage in mild to moderate physical activity to build up heart and lung stamina. Remember to consult your doctor before you start any exercise regimen.


2. Pneumonia

Computer-generated image of the bacteria that causes pneumonia.

Pneumonia is a lung infection that can be caused by a bacteria or a virus, and can lead to respiratory failure in patients with COPD. COPD weakens the respiratory system increasing vulnerability to pneumonia. Because people with COPD already have weakened airways and a worse immune system, the likelihood of them to die from pneumonia is higher than that of patients without COPD.

Symptoms of pneumonia usually include coughing, a fever, and having a difficult time breathing. Pneumonia is more common in COPD patients that take steroids for their symptoms. You should consider talking to your doctor about getting a pneumonia vaccine if you have not already gotten one.

One dose is usually enough for most people, a second dose may be suggested for some, including those that have been using steroids for a long time. Antibiotics can also be used to treat pneumonia caused by bacteria. Streptococcus pneumonia is the most common cause of bacterial pneumonia in patients with COPD. To reduce the risk of getting infected, you should;

  • Drink plenty of fluids especially water, to maintain healthy bronchioles while thinning out mucus and secretions.
  • Quit smoking.
  • Wash hands consistently.
  • Avoid contact with people you know are ill.
  • Discourage sick family members and friends from coming to visit your home.

Overall good health is key to preventing infections.


3. Depression

Stethoscope and card lying on a table with the word "depression" written on it.

Shortness of breath that limits your activities can have you feeling down in the dumps and lead to loss of interest or pleasure in activities. Having this feeling every once in a while is okay but when you feel this way frequently then you may be undergoing depression. One study estimated that 40 percent of people with COPD suffer from depression.

Depression can lead to the worsening of your physical symptoms because you may not fell like exercising and feeling low all the time might make it hard for you to follow your treatment plan.

You may even turn to alcohol, cigarette smoking or any other unhealthy habits to help you cope with depression which can lead to more harm to your body. Do not ignore how you are feeling and talk to your doctor about this so that they can get you the help that you need. Signs to look out for include;

  • Feeling guilty or worthless.
  • Being overly sensitive to criticism.
  • Feeling hopeless or suicidal.
  • Having trouble falling asleep or staying asleep.
  • Having trouble making decisions and concentrating.
  • Lethargy and lack of motivation.

Your doctor may recommend antidepressant medication or talk therapy. You may also decide to join a support group with other COPD patients or a pulmonary rehabilitation program to help you fight depression.


4. Osteoporosis

Close-up of plastic skeleton with osteoporosis.

This is a complication that sometimes occurs with COPD causing the weakening of the bones. Bones are made with living tissue and as older bone tissue breaks down, new bone tissue is created. When the nutrients in the body are not enough to create new bone tissue, the bones may become weak and fragile, and when this occurs, the risk of getting fractures is greatly increased. Although no exact reason can be given by researchers on the coexistence of COPD and osteoporosis, some theories for what the cause may be include;

  • Cigarette smoking – some researchers believe that some chemicals in cigarette smoke cause changes in the body, and these changes include genetic changes that may cause bones to become weak and slow to heal.

  • Corticosteroids – these are commonly used by COPD patients to control COPD flare-ups and to reduce airway inflammation, and a common side effect of corticosteroids is osteoporosis.

  • Low vitamin D levels – people with COPD may opt to stay indoors and lack of exposure to the sun, causing low levels of vitamin D. Low vitamin D levels have been linked to poor bone growth and skeletal mass, which may contribute to osteoporosis. 

Your doctor can check your bone health with a bone density scan. You may need prescription medicine along with calcium and vitamin D supplements to keep your bones strong. You may also want to exercise as research has shown that progressively harder weight-bearing exercise, such as strength training can boost bone health. Consult your doctor before you start any exercise regimen.


5. Trouble sleeping 

Looking through window at woman with hands on her face.

It is very common for people diagnosed with COPD to have trouble sleeping. In fact around 50 percent of COPD patients face this problem. This is a problem because getting enough sleep is vital for all body functions to work properly.

Sleeping problems linked with COPD include; low levels of oxygen during sleep, sleep apnea, depression, medication used to treat COPD symptoms and some of the COPD symptoms like coughing and wheezing.

You should let your doctor know if you are experiencing trouble sleeping so that he can figure out what is causing it and then treat it. A few things you can do to help with this problem include:

  • Keep the room that you sleep in cozy, dark, cool and quiet.
  • Practice airway clearance techniques throughout the day and right before you sleep to remove secretions in your airways.
  • Ask your doctor if night-time use of supplemental oxygen is an option for you.
  • Review the medicine that you are using with your doctor to see if it has any side effects. You may require an adjustment.
  • Talk to your doctor about non-invasive positive-pressure ventilation (NIPPV) such as CPAP if you suffer from sleep apnea or other sleeping disorders.
  • Try not to drink caffeinated beverages late in the day or avoid them altogether.
  • Do not sleep lying flat. Elevate your upper body with pillows to help facilitate breathing.




6. Pneumothorax 

Computer-generated image of a human body and the lungs.

Pneumothorax, which is also referred to as a collapsed lung, occurs when a hole develops in the lung, allowing air to escape into the space around the lung causing the lung to partially or completely collapse.

People diagnosed with COPD are at higher risk of getting pneumothorax because the structure of their lungs is weak and vulnerable to the development of these types of holes. It can be caused by an injury to the lung, rib fracture, certain medical procedures and in some cases air pressure changes for example high altitude. 

Signs to look out for include sudden sharp chest pains that worsen when you take a deep breath, rapid heartbeat, chest tightness, and cyanosis caused by lack of oxygen.

Pneumothorax can be treated by inserting a chest tube between the ribs into the space between the lung and the chest wall to help remove the air and re-inflate the lung. The chest tube stays in place for a number of days as the patient recovers in hospital. In some rare cases, surgery is required to prevent future occurrences.


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