End-Stage COPD: Tips for Daily Living and Palliative Care (2023)


Chronic obstructive pulmonary disease (COPD) is a progressive condition that affects a person’s ability to breathe well. It encompasses several medical conditions, including emphysema and chronic bronchitis.

In addition to a reduced ability to breathe in and out fully, symptoms can include a chronic cough and increased sputum production.

Read on to learn about ways to alleviate end-stage COPD symptoms and factors that play into your outlook if you have this difficult condition.

End-stage COPD is marked by severe shortness of breath (dyspnea), even when at rest. At this stage, medications typically don’t work as well as they had in the past. Everyday tasks will leave you more breathless.

End-stage COPD also means increased visits to the emergency department or hospitalizations for breathing complications, lung infections, or respiratory failure.

Pulmonary hypertension is also common in end-stage COPD, which can lead to right-sided heart failure. You may experience an accelerated resting heart rate (tachycardia) of more than 100 beats per minute. Another symptom of end-stage COPD is ongoing weight loss.

If you smoke tobacco products, quitting is one of the best things you can do at any stage of COPD.

Your doctor can prescribe medications to treat COPD that may also relieve your symptoms. These include bronchodilators, which help to widen your airways.

There are two types of bronchodilators. The short-acting (rescue) bronchodilator is used for the sudden onset of shortness of breath. The long-acting bronchodilator can be used every day to help control symptoms.

Glucocorticosteroids may help reduce inflammation. These medications can be delivered to your airways and lungs with an inhaler or a nebulizer. A glucocorticosteroid is commonly given in combination with a long-acting bronchodilator for treatment of COPD.

An inhaler is a pocket-sized portable device, while a nebulizer is larger and meant primarily for home use. While an inhaler is easier to carry around with you, it’s sometimes harder to use correctly.

If you have a difficult time using an inhaler, adding a spacer can help. A spacer is a small plastic tube that attaches to your inhaler.

(Video) End-Stage COPD: Tips for Daily Living and Palliative Care | Chronic obstructive pulmonary disease

Spraying your inhaler medication into the spacer allows for the medication to mist and fill the spacer prior to breathing it in. A spacer may help more medicine to get into your lungs and less to be trapped on the back of your throat.

A nebulizer is a machine that turns a liquid medicine into a continuous mist that you inhale for around 5 to 10 minutes at a time through a mask or mouthpiece connected by tube to the machine.

Supplemental oxygen is typically needed if you have end-stage COPD (stage 4).

The use of any of these treatments is likely to increase significantly from stage 1 (mild COPD) to stage 4.

You may also benefit from exercise training programs. Therapists for these programs can teach you breathing techniques that reduce how hard you have to work to breathe. This step can help enhance your quality of life.

You may be encouraged to eat small, high-protein meals at each sitting, such as protein shakes. A high-protein diet can improve your well-being and prevent excess weight loss.

In addition to taking these steps, you should avoid or minimize known COPD triggers. For example, you may have greater difficulty breathing during extreme weather conditions, such as high heat and humidity or cold, dry temperatures.

Although you can’t change the weather, you can be prepared by limiting the time you spend outdoors during temperature extremes. Other steps you can take include the following:

  • Always keeping an emergency inhaler with you but not in your car. Many inhalers operate most effectively when kept at room temperature.
  • Wearing a scarf or mask when going outside in cold temperatures can help warm the air you breathe in.
  • Avoid going outdoors on days when the air quality is poor and smog and pollution levels are high. You can check the quality of the air around you here.

Palliative care or hospice care can greatly enhance your life when you’re living with end-stage COPD. A common misconception about palliative care is that it’s for someone who will be passing away soon. This isn’t always the case.

Instead, palliative care involves identifying treatments that can enhance your quality of life and help caregivers provide you with more effective care. The main goal of palliative and hospice care is to ease your pain and control your symptoms as much as possible.

(Video) End-Stage COPD: Tips for Daily Living & Palliative Care

You’ll work with a team of doctors and nurses in planning your treatment goals and caring for your physical and emotional health as much as possible.

Ask your doctor and insurance company for information about palliative care options.

COPD has four stages, and your airflow becomes more limited with each passing stage.

Various organizations may define each stage differently. However, most of their classifications are based in part on a lung function test known as the FEV1 test. This is the forced expiratory volume of air from your lungs in one second.

The result of this test is expressed as a percentage and measures how much air you can let out during the first second of a forced breath. It’s compared to what is expected from healthy lungs of similar age.

According to the Lung Institute, the criteria for each COPD grade (stage) are as follows:

GradeNameFEV1 (%)
1mild COPD≥ 80
2moderate COPD50 to 79
3severe COPD30 to 49
4very severe COPD or end-stage COPD< 30

The lower grades may or may not be accompanied by chronic symptoms, such as excess sputum, noticeable shortness of breath with exertion, and chronic cough. These symptoms tend to be more prevalent as COPD severity increases.

In addition, new Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines further categorize people with COPD into groups labeled A, B, C, or D.

The groups are defined by the seriousness of problems such as dyspnea, fatigue, and interference with daily living, as well as acute exacerbations.

Exacerbations are periods when symptoms get noticeably worse. Exacerbation symptoms can include a worsening cough, increased yellow or green mucus production, more wheezing, and lower oxygen levels in the bloodstream.

Groups A and B include people who’ve had no exacerbations in the past year or only a minor one that didn’t require hospitalization. Minimal to mild dyspnea and other symptoms would put you in Group A, while more serious dyspnea and symptoms would place you in Group B.

Groups C and D indicate that you’ve either had at least one exacerbation that required hospital admission in the past year or at least two exacerbations that did or didn’t require hospitalization.

Milder breathing difficulty and symptoms put you in Group C, while having more breathing troubles means a Group D designation.

People with a stage 4, Group D label have the most serious outlook.

Treatments can’t reverse damage that’s already been done, but they can be used to try to slow down COPD’s progression.

(Video) Palliative and End-of-life Care for Pulmonary Patients

In end-stage COPD, you’ll likely need supplemental oxygen to breathe, and you may not be able to complete activities of daily living without becoming very winded and tired. Sudden worsening of COPD at this stage can be life-threatening.

While determining the stage and grade of COPD will help your doctor choose the right treatments for you, these aren’t the only factors that affect your outlook. Your doctor will also take into account the following:


Although being overweight can make breathing more difficult if you have COPD, people with end-stage COPD are often underweight. This is partly because even the act of eating can cause you to become too winded.

Additionally, at this stage, your body uses up a lot of energy just to keep up with breathing. This can result in extreme weight loss that affects your overall health.

Shortness of breath with activity

This is the degree to which you get short of breath when walking or other physical activities. It can help determine the severity of your COPD.

Distance walked in six minutes

The farther you can walk in six minutes, the better outcome you will likely have with COPD.


With age, COPD will progress in severity, and the outlook tends to become poorer with passing years, especially in seniors.

Proximity to air pollution

Exposure to air pollution and secondhand tobacco smoke can further damage your lungs and airways.

Smoking can also affect outlook. According to a 2009 study that looked at 65-year-old Caucasian males, smoking reduced life expectancy for those with end-stage COPD by almost 6 years.

Frequency of doctor’s visits

Your prognosis is likely to be better if you adhere to your recommended medical therapy, follow through with all of your scheduled doctor’s visits, and keep your doctor up to date on any changes in your symptoms or condition. You should make monitoring your lung symptoms and function a top priority.

Dealing with COPD can be challenging enough without feeling lonely and scared about this disease. Even if your caregiver and the people closest to you are supportive and encouraging, you may still benefit from spending time with others who have COPD.

Hearing from someone going through the same situation may be helpful. They might be able to provide some valuable insight, such as feedback about various medications you’re using and what to expect.

Maintaining your quality of life is very important at this stage. There are lifestyle steps you can take, such as checking air quality and practicing breathing exercises. However, when your COPD has progressed in severity, you may benefit from additional palliative or hospice care.

(Video) Management of End Stage COPD & Dyspnea - Dr. Serife Eti


I’m interested in getting a humidifier for my COPD. Would this help or hurt my symptoms?

Anonymous patient


If your breathing is sensitive to dry air and you live in a dry environment, then it may be beneficial to humidify the air in your home, as this could help to prevent or reduce your COPD symptoms.

However, if the air in your home is already adequately humidified, too much humidity could make it more difficult to breathe. Around 40 percent humidity is considered ideal for someone with COPD.

In addition to a humidifier, you can also purchase a hygrometer to accurately measure humidity inside your home.

Another consideration with a humidifier is making sure cleaning and maintenance are properly performed on it to prevent it from becoming a harbor for mold and other contaminants, which could end up harming your breathing.

Ultimately, if you’re considering using a humidifier, you should first run this by your doctor, who can help you determine if this may be a helpful option for improving your breathing in light of your condition.

Stacy Sampson, DOAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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2. Struggle to Breathe: COPD (Chronic Obstructive Pulmonary Dise
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3. End of life care Chapter 4 Symptoms of approaching death
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4. Palliative care in Chronic lung disease- Is it end of life care?
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6. Surgical Options for End Stage Lung Disease


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