Complications of COPD: Everything You Need to Know
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What Are the Complications of COPD?

What Are the Complications of COPD?
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Updated on June 17, 2024
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Chronic obstructive pulmonary disease, or COPD, is an umbrella term for a group of diseases that includes chronic bronchitis and emphysema. COPD progresses gradually, and as it does so, there are several possible complications that may occur.

While COPD is a long-term respiratory disease, its effects and potential complications aren’t limited to the lungs and airways. COPD and the medications used to treat it can impact many parts of the body over time and lead to a variety of complications, including heart problems, osteoporosis, and depression.

The good news is that by working with your doctor to manage your COPD and slow its progression you can significantly reduce your likelihood of developing COPD complications. With that said, read on to learn more about the potential complications of COPD.

Exacerbations

The most common complication of COPD is an exacerbation. This is a flare-up in which respiratory symptoms suddenly worsen. “At least half of patients will have an exacerbation, and there is a subset of people who have them once or twice a year or even more frequently,” says Carrie Pistenmaa, MD, a pulmonologist at Brigham and Women’s Hospital in Boston. These flares also become more common as COPD progresses, she adds.

Most COPD exacerbations are triggered by respiratory viruses and bacteria. These infect the lower airway and increase airway inflammation.

Exacerbations can also occur from inhaling irritating substances from the environment, such as air pollution or allergens.

Symptoms of an exacerbation include:

  • Increased shortness of breath
  • Wheezing
  • Chest tightness
  • Increased mucus production or a change in mucus color
  • Worsening of a chronic cough or development of a new cough
You can treat some exacerbations at home with increased use of rescue inhalers, nebulizers, and steroids. If the exacerbation is caused by an infection, a doctor may prescribe antibiotics. If your symptoms become severe, you may need to seek emergency medical care.

Unfortunately, you can’t completely prevent exacerbations from occurring, but there are ways to limit their frequency and severity.

Here are some steps you can take:

  • If you smoke, get help to quit.
  • Avoid being around others with colds or the flu.
  • Stay current with vaccinations, including those for COVID-19, flu, RSV, and pneumonia.
  • Stick to your treatment regimen even on days when you’re feeling well.
  • Wash your hands often, and use hand sanitizer when you don’t have access to a sink.
  • Consider wearing a mask on days with high levels of air pollution.

Pulmonary Hypertension

COPD can lead to pulmonary hypertension. This is a condition in which blood pressure in the arteries that carry blood from the heart to the lungs is elevated.

“People with COPD often have low levels of oxygen in the blood, which is known as hypoxia,” says Dr. Pistenmaa. “Over time, hypoxia can cause the vessels [between the heart and lungs and within the lungs] to constrict, which increases the pressure in those arteries.” Eventually, even mildly low oxygen levels can lead to pulmonary hypertension, she adds.

Emphysema, which causes damage to the air sacs in the lungs, can also destroy small blood vessels in the lungs. This further increases pressure in other vessels.

With pulmonary hypertension, the right side of your heart has to work harder to move blood through the lungs. This can cause the right side of the heart to enlarge and ultimately fail, a condition called right-sided heart failure, or cor pulmonale.

Early signs of pulmonary hypertension include shortness of breath, light-headedness during physical activity, or palpitations (fast heart rate). Over time, symptoms may occur with lighter activity or even while at rest.

As pulmonary hypertension progresses, other symptoms include:

  • Ankle and leg swelling
  • Bluish color of the lips or skin
  • Chest pain or pressure, most often in the front of the chest
  • Dizziness or fainting spells
  • Fatigue
  • Increased abdomen size
  • Weakness

Mild pulmonary hypertension typically doesn’t require any treatments other than management of the underlying COPD, says Pistenmaa. That said, if your blood oxygen levels are low at rest or while exercising, supplemental oxygen may help reduce the stress on the heart.

If you develop moderate to severe pulmonary hypertension, you may need to take blood thinners and use oxygen therapy at home. In rare cases, people with severe pulmonary hypertension may need to undergo a lung or heart-lung transplant.

Collapsed Lung

COPD increases the risk of a partial or complete lung collapse, a condition called a pneumothorax.

Pneumothorax happens when lung tissue damaged by COPD allows air to leak into the space between the lungs and chest (the pleural cavity). Because that air has nowhere to go, it builds up pressure between the chest wall and the lungs. This pressure increases until it can cause the lungs to compress or collapse.

A collapsed lung can happen suddenly and without any warning. It’s usually accompanied by sudden, sharp pain in the chest and worsened shortness of breath.

“If you suspect you have pneumothorax, you should go to the emergency room right away,” says Pistenmaa. A chest X-ray can confirm the diagnosis.

If there is a large amount of air around the lung, a doctor may insert a small tube into the chest cavity to allow the trapped air to escape and relieve the pressure. Once this chest tube is inserted, it typically takes about 48 hours or so for the lung to heal.

The more advanced your COPD, the more likely you are to experience a collapsed lung. As a result, the best way to reduce your risk of pneumothorax is to get the right treatment for your COPD, notes Pistenmaa.

It’s also important to recognize and treat exacerbations early. This can reduce your risk of lung damage that can lead to a collapsed lung.

Osteoporosis

Many people with COPD develop osteoporosis. This is a disease that weakens bones to the point where they break easily after minor trauma. Nearly 40 percent of people with COPD also have osteoporosis.

COPD itself puts people at higher risk of osteoporosis.

 This is likely due to a number of factors. For one, many people with COPD use inhaled or oral steroids, which are known to interfere with the metabolism of calcium (the mineral needed to build bone) and also vitamin D (which is necessary to absorb calcium). Some patients with later-stage COPD also end up malnourished, which can lead to a calcium and vitamin D deficiency, Pistenmaa says.

COPD symptoms, such as breathlessness and fatigue, can interfere with your ability to exercise and be active. Inactivity can cause a gradual loss of bone density and the development of osteoporosis.

There are a number of ways people with COPD can protect their bones and reduce their risk of osteoporosis and fractures. Some key steps you can take:

  • If you smoke, get help to quit.
  • Eat a healthy diet rich in calcium and vitamin D.
  • Do weight-bearing exercise, such as walking, lifting weights, or working out with stretch bands — these activities stimulate bones to rebuild and become denser.
  • Talk to your doctor about taking daily calcium and vitamin D supplements.
Your doctor may also want to perform a DEXA scan, which is a low-radiation X-ray that measures the density of the minerals in your bones (typically in the spine and hip). If a scan reveals you have osteoporosis, you may need to take bone-strengthening medication, such as a bisphosphonate (given by mouth or by IV) or denusomab (given by injection).

Anxiety and Depression

The physical challenges involved in living with COPD can also take a significant toll on your mental and emotional health. Perhaps not surprisingly, people with COPD are at higher risk of anxiety and depression than the general population.

An estimated 40 percent of people with COPD experience clinical depression, which is defined as a feeling of deep sadness or emptiness that lasts longer than a couple of weeks.

“There is some suffering that goes along with COPD, and depression can be caused by not feeling well or not feeling as well as you used to feel and not being able to do things that you might want to do,” Pistenmaa notes.

Clinical anxiety, which is defined as constant worrying and anticipating the worst in a way that makes it hard to function, affects an estimated 36 percent of people with COPD.

“The shortness of breath that comes along with COPD can lead to a vicious cycle in which the breathlessness makes you feel anxious, then that anxiety makes you breathe even faster, which can further increase anxiety,” says Pistenmaa. “This can spiral and lead to a panic attack.”

Indeed, the prevalence of panic disorder, in which you often experience sudden attacks of fear that last several minutes, is roughly 10 times higher in people with COPD than those without the disease.

While anxiety and depression are common in COPD, they are not inevitable, and there are many things you can do to feel better and improve your quality of life. This includes staying active and involved in activities you enjoy, getting regular exercise, and doing relaxation exercises and breathing techniques to ease breathlessness.

If you frequently feel sad or anxious, let your doctor know. Your physician can recommend coping strategies and may refer you to a counselor, psychologist, or psychiatrist. These mental health professionals can help you change negative patterns of thinking and behaviors and reduce anxiety and depression through different types of talk therapy or medication.

The Takeaway

COPD is a chronic condition that can lead to complications, such as pulmonary hypertension, collapsed lung, anxiety and depression, and osteoporosis. Fortunately, there are several things you can do to lower your risk of developing these complications. Quitting smoking, following your medication regimen, ensuring you are getting enough exercise, and eating a healthy diet will all work toward helping you manage your condition and reducing flare-ups. Talk to your doctor to find out what else you can do to minimize your risk of COPD complications.

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Michael S. Niederman, MD

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From NewYork-Presbyterian, Castle Connolly Top Doctor

Michael S. Niederman, MD, is the lead academic and patient quality officer in the division of pulmonary and critical care medicine at Weill Cornell Medical Center in New York City; a professor of clinical medicine at Weill Cornell Medical College; and Lauder Family Professor in Pulmonary and Critical Care Medicine. He was previously the clinical director and associate chief in the division of pulmonary and critical care medicine at Weill Cornell Medical Center. 

His focus is on respiratory infections, especially in critically ill patients, with a particular interest in disease pathogenisis, therapy, and ways to improve patient outcomes. His work related to respiratory tract infections includes mechanisms of airway colonization, the management of community- and hospital-acquired pneumonia, the role of guidelines for pneumonia, and the impact of antibiotic resistance on the management and outcomes of respiratory tract infections.

He obtained his medical degree from Boston University School of Medicine, then completed his training in internal medicine at Northwestern University School of Medicine, before undertaking a pulmonary and critical care fellowship at Yale University School of Medicine. Prior to joining Weill Cornell Medicine, he was a professor in the department of medicine at the State University of New York in Stony Brook and the chair of the department of medicine at Winthrop-University Hospital in Mineola, New York, for 16 years.

Dr. Niederman served as co-chair of the committees that created the American Thoracic Society's 1993 and 2001 guidelines for the treatment of community-acquired pneumonia and the 1996 and 2005 committees that wrote guidelines for the treatment of nosocomial pneumonia. He was a member of the American Thoracic Society/Infectious Diseases Society of America committee that published guidelines for community-acquired pneumonia in 2007. He was also the co-lead author of the 2017 guidelines on nosocomial pneumonia, written on behalf of the European Respiratory Society and the European Society of Intensive Care Medicine.

He has published over 400 peer-reviewed or review articles, and has lectured widely, both nationally and internationally. He was editor-in-chief of Clinical Pulmonary Medicine, is an associate editor of Critical Care and the European Respiratory Review, and serves on the editorial boards of Critical Care Medicine and Intensive Care Medicine. He has previously served on the editorial boards of the American Journal of Respiratory and Critical Care Medicine and Chest. For six years, he was a member of the Board of Regents of the American College of Chest Physicians, and in 2013, he was elected as a master of the American College of Physicians.

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Julia Califano is an award-winning health journalist with a passion for turning complex medical research and information into news you can actually use and understand. She strives to help people feel more in control of their lives, conditions, and overall health.

In addition to Everyday Health, Julia's work has been featured in SELF, Good Housekeeping, Women’s Health, Health, DailyWorth, More, Food & Wine, Harper's Bazaar, the Slingshot Fund, Glamour, and Time Inc. Content Solutions, to name a few. She has also served as an editor and writer at Condé Nast, Hearst, and Time Inc.

Outside of work, Julia's favorite things include photography, summers on Cape Cod, good coffee, hiking, and (when her kids allow it) reading. She lives in the New York City area with her husband and two sons.

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