Which of the following is a late sign of COPD?

• A. Dyspnea on exertion
• B. Wheezing
• C. Polycythemia
• D. Cough with sputum

Answer: (C)

Chronic hypoxemia from long-standing COPD leads to secondary polycythemia as the body tries to compensate by making more red blood cells. This adaptation takes time, so elevated hematocrit or hemoglobin is a later finding in the disease course. Early COPD signs are usually respiratory and relate to airway obstruction—dyspnea on exertion and a productive cough are common early symptoms, and wheezing can occur as well but isn’t a late sign. As COPD progresses and hypoxemia persists, the kidneys release more erythropoietin, increasing red cell mass, which raises blood viscosity and can contribute to complications like right heart strain (cor pulmonale). So the presence of polycythemia reflects chronic hypoxemia and advanced disease, making it a late sign.