The symptoms of C.O.P.D tend to depend on which disease is more prominent in an afflicted individual. If emphysema is the predominant disease, the first noticeable symptom will be a shortness of breath during physical exertion. This will soon be followed by a phlegmatic cough and pursed-lip breathing. If chronic bronchitis predominates, a persistent, mucus-filled cough will often be the first symptom to appear. This may be accompanied by wheezing, shortness of breath, fatigue, and respiratory or lung infections.