Extreme fatigue is one of my first signs along with increased sputum production and low grade fevers. I don't usually spike high fevers unless I am really sick, then I know I am in serious trouble and need help quickly. I also am more short of breath, my usually climbable stairs becomes a near impossibility and I just don't care about anything around me except for how I can squeeze extra sleep in. I also notice that food isn't quite as appealing either, even my favorite stuff. When this happens, it usually means IV's...PO rarely works for me anymore.