The 4 Stages of COPD: What You Need to Know (2023)

Feb 28, 2018 6:13:32 AM / by Duke Reeves

The 4 Stages of COPD: What You Need to Know (1)

Being diagnosed with COPD can be a very frightening and disheartening experience. It's common to feel fear and apprehension about living with the diagnosis and maybe even guilt about what you did or didn't do that might have caused your COPD.

But the most important thing to understand about your COPD diagnosis is that, with an effective treatment planand healthy lifestyle changes, you can take control and slow the progression of your disease.

According to theGOLD System(developed by the Global Initiative for Chronic Obstructive Lung Disease), COPD progresses through four typical stages, with Stage1 being the most mild and Stage 4 the most severe.

Based on your symptom severity and lung function tests (spirometry), your doctor will determine what stage your disease is at. GOLD also just released new guidelines that take your COPD assessment test score and your exacerbation history into account as well.

However, the most common practice used by doctors to classify stages of COPD is using your symptom severity and your lung function tests to determine your stage.

This article will introduce you to the 4 stages of COPD and what to expect at each point. We want to help you better understand your disease, your symptoms, and how to take care of yourself and stay as healthy as possible.

Some COPD patients feel helpless to control their disease, but the only way to slow COPD symptoms from worsening is to take a proactive role in your own health and treatment. With the help of their doctors and healthy lifestyle changes, many people with COPD live long, full, and active lives.

Takethe COPD Athlete, Russel Winwood, for example. He has spent his life since his diagnosis living an extremely active lifestyle, and runs marathons and trains for triathlons despite having Stage 4 COPD.

He's used his own example to encourage others with COPD and other respiratory diseases to work hard and keep up hope. He is proof that you can maintain an active, high quality of living with enough effort and dedication.

And just because Russel is training for triathlons doesn't mean that's what you have to do to live a full and happy life. That's his passion and he doesn't let his COPD dictate his life. You can still follow your passion and live your life to the fullest too!

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Stage 1: Mild COPD

COPD stage 1is the first, most mild stage of the disease. In fact, the symptoms are usually so mild that most people don't realize that they have a health problem. Typically people think their symptoms are just signs of aging or long-term smoking because the symptoms aren't debilitating. They just brush them under the rug.

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Unfortunately, this means that many people ignore the early symptoms of COPD and wait too long to go see a doctor. These are some of the warning signs that you might have COPD:

  • Constantly short of breath after simple tasks
  • Changes in the consistency and color of your mucus
  • Chronic cough for no apparent reason
  • Have a hard time breathing while laying down

If you experience any of these warning signs, it's important not to brush off mild respiratory ailments and see a doctor for advice as soon as possible. Catching the disease early is key so that you have time to take medications and make healthy lifestyle changes to prevent it from worsening.

At stage 1,COPD is still very treatable, so it's important to take advantage of all the available treatments and make lasting lifestyle changes. It's especially important to stay active and exercise regularly while your symptoms are still mild.

Stage 1 COPD Symptoms

COPD is often the last thing people consider when they have respiratory issues, but it's important to pay attention to your symptoms and consider any warning signsyou might have.

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If you are or have been a smoker, have been exposed to lung irritants at home or work, or have had heavy exposure to other chemicals or pollutants, you need to be especially vigilant.

Here are the most common symptoms of Stage 1 COPD:

  • Slight airflow limitations
  • Chronic cough and/or wheezing
  • More mucus/sputum production in airways
  • Fatigue (you notice that you get tired more easily than usual)
  • FEV1 Value of at least 80% of normal (Your FEV1 is a measure of the amount of air you can exhale in 1 second)

As you can see, stage 1 COPD symptoms are easy to mistake for a benign condition like allergies, the common cold, or a natural part of aging. COPD can be tricky that way, and that's why it's important to take these symptoms seriously and talk to a doctor as soon as possible. Especially if your symptoms are persistent.

Stage 1 COPD Treatment Options

If you've been given a stage 1 diagnosis, you have a huge advantage when it comes to slowing the progression of your disease. The best time to diagnose COPD is at stage 1, because there is still plenty of time to make healthy lifestyle changes and you are still living a fairly normal and active life.

At stage 1, symptoms are usually very mild and most treatment options focus on prevention of further symptoms. By developing healthy lifestyle habits like eating clean, exercising regularly, and being social while alsoclosely monitoring your symptoms, you will have a much easier time managing your COPD and slowing its progression.

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While COPD is not curable, it is very treatable. Your disease will likely progress to a later stage, but early treatment can greatly slow the disease's progression. These are some of the recommended treatment options for stage 1 COPD.

Quit Smoking

If you are a smoker, then the number one, most important important thing you can do to treat your COPD is to quit. As soon as you get your COPD diagnosis, you should seek out and utilize whateversmoking cessation resourcesare available to you.

Quitting smoking is certainly not easy, but if you have COPD, it's the only way to prevent your health from rapidly declining. If you don't quit immediately, you will almost certainly see your symptoms get quickly and permanently more severe.

Don't be afraid to ask for help. Talk to your doctor about smoking cessation medications, and enlist your friends and family for support. There are even government and state programs that will give you nicotine patches or gum for free by signing up for their program.

But I'm notgoing to beat a dead horse here... There are so many articles on quitting smoking and I'm sure you've heard all of the tips more than once.

I will leave you with one little piece of advice that might not be listed. Join Facebook support groups. You will be able to connect with people who are going through the same battle as you and people who have successfully quit so you have numerous people to rely on for support.

Avoid Lung Irritants

Quitting smoking is one part of avoiding lung irritants, but there are other chemicals and air conditions that you should also avoid if you have COPD.

If you have allergies, you already know that it can affect your airways and ability to breathe. But dust and pollution are lung irritants as well, and you should avoid them to prevent your COPD symptoms from flaring up.

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(Video) Stages of COPD

Even if you don't notice your symptoms getting worse from dust and smog, they could still be causing damage to your lungs and should be avoided. The more total exposure you have to these lung irritants, the more quickly your disease will progress.

Key lung irritants to avoid:

  • Air pollution and smog
  • Dust (consider using an air filter or dust mask in places you might be exposed)
  • Pollen (if you have allergies)
  • Chemicals found in household (and industrial) cleaning products
  • Strong perfume or cologne (including other scented products like lotions and shampoos)
  • Smoke (including secondhand smoke, incense, burning wood, etc.)
  • Aerosols (like air fresheners and disinfectants)
  • Extreme weather conditions (extreme heat, extreme cold, and humidity)

Healthy Diet & Nutrition

It's important to start making changes to your diet as soon as you get your diagnosis, because it can do wonders for your overall health. And when you have COPD, it's especially important to keep your body in the best possible shape.

Your doctor will help you work out a diet that's tailored to your needs, depending on your age, current diet, disease stage, and other factors. Make sure not to make any major, sudden changes to your diet without consulting your doctor first.

Here are some foods that are healthy for people with COPD:

  • Choose lean proteins (chicken, fish, turkey)
  • Eat plenty of fruits and vegetables
  • Eat whole grains and avoid processed foods
  • Take necessary vitamins and supplements as recommended by your doctor
  • Drink plenty of water and avoid sugary drinks (like soda and fruit juices)

These are recommendations that any healthy adult, not just people with COPD, should follow. But as someonewith COPD, it's especially important for you to avoid unhealthy foods and give your body the proper nutrition it needs.

Here are some foods that arenot healthyfor people with COPD:

  • Fried and processed foods (e.g. fast food, processed snacks, and processed meats)
  • Caffeinated and sugary beverages
  • Foods high in salt
  • Foods that cause heartburn or acid reflux
  • Nitrates and sulfites
  • Alcoholic beverages (they can slow your breathing rate)

Get More Physical Activity

Developing good exercise habits as soon as possible is extremely important if you have COPD. The longer you wait, the worse your symptoms will get. If you can build good exercise habits while you're still at stage 1—when symptoms are still mild—it will be easier to remain physically activity as time goes on.

If you wait until a later stage, you'll find that the worsened symptoms like coughing, wheezing, and restricted airways make it especially difficult to stick with an exercise routine. It will be even worse if you haven't ever been very active before.

Even though you might feel winded and have difficulty breathing at times, it will get easier as you build strength. But it's important that you don't over do it. If you feel like you can't keep going, that's okay. Just keep trying and your whole body will feel stronger and healthier. Not to mention,you'll have more energy and endurance.

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Not only is exercise good for you overall, regular cardiovascular activity can actually strengthen the muscles around your lungs. This can help lessen your COPD symptoms, making it easier to breathe.

Here are some of the benefits you can get from following an exercise plan with COPD:

  • Improved circulation and oxygen delivery throughout your body
  • Improved oxygen efficiency (your lungs won't have to work as hard to deliver enough oxygen)
  • Stronger muscles around your lungs
  • A boost to your immune system
  • More energy and endurance

Get Vaccinated

People with COPD are more prone to complications when they get sick with the flu or other viruses. Getting a respiratory illness could lead to exacerbations of existing symptoms.

Vaccinations won't help reduce any of the symptoms you already have, but it can help keep them from getting worse. A bad flu can cause COPD troubles to flare up and linger, sometimes causing a permanent worsening of symptoms.

Since COPD patients have a higher risk of complications and hospitalizations, it's especially important that they protect themselves from respiratory illnesses like Pneumonia and the flu. By keeping up with your yearly vaccinations, you'll have an extra layer of protection against this risk.

Short-Acting Bronchodilators

At stage 1, there is usually minimal, if any, medication required to control symptoms. Breathing issues are usually mild, and long-term medication is not usually necessary.

That said, the first prescription medication most people with COPD get is one for a short-acting bronchodilator. This kind of inhaler is meant to be used on-demand, when you need temporary relief from mild symptoms.

Short-acting bronchodilators contain a medication that relaxes the muscles around your lungs and makes it easier to breathe. Most doctors will instruct you to use them as needed when your symptoms flare up.

Here are a couple examples of short-acting bronchodilator medications:

  • Anticholinergics (e.g. ipratropium)
  • Beta 2-agonists (e.g. albuerol or levalbuterol)
  • Sometimes your doctor will prescribe a combination of two short-acting bronchodilators

Overview of Stage 1

While a COPD diagnosis is never good news, if you're diagnosed at stage 1, you are luckier than most with the disease. You still have many viable treatment options ahead of you and the opportunity to improve your overall health before your symptoms worsen.

Little, if any, medication is needed at stage 1, and your treatment plan will likely focus on preventative maintenance and healthy habits like diet and exercise. It's also important to avoid environmental irritants like secondhand smoke, household chemicals, and prolonged exposure to allergens.

You can greatly improve your symptoms and prognosis if you stop smoking, develop healthy eating habits, avoid lung irritants, and get more physical activity right away. Building these skills early on is key for maintaining a good quality of life with COPD.

Stage 2: Moderate COPD

At stage 2 of the disease,COPD symptomsbecome more pronounced and new symptoms may appear. This is the stage that many people start to notice their breathing difficulties and decide to seek help from a doctor.

At this point, lung function has declined further than stage 1, and the signs of COPD are more obvious. At this point, patients might be prescribed longer-lasting medications to deal with chronic symptoms and might be referred to a COPD support program to better learn how to manage their disease.

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Stage 2 COPD Symptoms

With stage 2 COPD, you will notice symptoms that are more noticeable and more persistent than they were at stage 1. You might also notice some new symptoms, like chronic breathlessness or difficulty coughing up mucous.

Here are the symptoms characteristic of Stage 2 COPD:

  • Worsening airflow restriction
  • Worsening breathlessness, especially after heavy activity
  • Increased mucous and phlegm in airways
  • Persistent, chronic coughing
  • Difficulty expelling phlegm from lungs
  • FEV1 Value of 50-79% of normal

Whereas you might have been able to brush off your symptoms at stage 1, at stage 2 they often become too obvious to ignore. It's important to seek treatment from a medical professional knowledgeable about COPD in order to properly manage your symptoms.

Treatment Options

At stage 2, you will have all of the treatment options that were available at stage 1 plus more. You are likely to need some kind of medication to help with your symptoms.

Even if you are already using short-acting bronchodilators, your doctor might prescribe you a more long-term medication to help with chronic symptoms.

If you are having difficulty exercising and managing your symptoms, your doctor might also refer you to pulmonary rehab to help you get a jump-start on healthier habits.

Pulmonary Rehabilitation

Many doctors suggestpulmonary rehabilitationto patients who have difficulty managing their symptoms and changing their diet and exercise routines.

However, pulmonary rehab programs are a good idea for anyone diagnosed with COPD, as they encompass a variety of educational, psychological, and physical activity programs to help people with respiratory conditions.

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Pulmonary rehabilitation programs are like a COPD boot camp, and attending one is a great way to kick-start your treatment. They are run by qualified therapists and health professionals who can help you learn and practice healthy habits.

(Video) Stages of COPD

Pulmonary Rehab: Education

It's important to know as much as you can about your disease so you can take an active role in managing it. Pulmonary rehabilitation programs put a strong focus on helping people understand COPD and respiratory health so they can make more informed and healthy decisions.

Unlike a regular health lecture, lessons from pulmonary rehab are tailored to be practical and relevant to YOU. After all, it would be tragic if your symptoms worsened or your disease progressed because you didn't have the information you need to understand and manage COPD.

A good pulmonary rehabilitation program will teach you everything you need to know about your disease and how to manage it, so you have everything you need to keep your COPD in check. What's more, you will also receive counseling on how to manage your disease emotionally and stay motivated to follow your treatment plan in the face of adversity.

Here are some topics that you can learn more about in pulmonary rehab:

  • How to cope with your illness
  • How to seek support from doctors, family, and friends
  • How to keep up and comply with your treatment plan
  • Exercises and techniques for better breathing
  • Physical activities that are particularly helpful for people with COPD
  • Techniques for how, when, and how often to use your inhaler

Once you complete a pulmonary rehabilitation program, the knowledge you've gained will give you a solid foundation for living with COPD.

Pulmonary Rehab: Diet and Exercise

Maintaining a healthy diet and getting enough physical activity is themost importantpart of managing COPD. That's one thing that pulmonary rehabilitation programs are good for—helping you to understand what proper nutrition and exercise looks like when you have COPD.

It will help you understand not only what kind of exercises to do and how often to do them, but also the reasons and theory behind why they will help you. It's much easier to stay motivated and stick with a healthy routine when you understandwhyit's beneficial, instead of just doing it because someone told you to.

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Here are some things you can learn about diet and exercise in pulmonary rehab:

  • What regular activity and exercise should look likelihood
  • Why regular exercise is important, and how it will help your COPD
  • Breathing techniques to make physical activity easier
  • Foods and drinks that can worsen COPD symptoms
  • Tips for planning and preparing healthy meals
  • And much more!

Pulmonary Rehab: Support Groups

One thing you can't underestimate when you have a chronic illness is the power of a support system. Having people around you to help and support you as you manage your COPD can help you stay motivated and hopeful.

One thing that's great about pulmonary rehab is that it gives you access to a wider support system of doctors and other patients with COPD. Through regular support group meetings, you can meet other people who are going through the same thing as you and share your challenges and successes.

Pulmonary rehab is a great way to find new friends, discover new COPD resources, and build the skills you need to stay healthy and slow your disease's progression. You might even find people to stay in contact with after the program is over, so you can continue to have a support system.

It's important to have friends to share your hopes, fears, victories, and setbacks with so you can stay strong and vigilant in managing your COPD. But don't forget to have fun and relieve stress with friends, too; a little relaxation can go a long way toward feeling better!

Long-Acting Bronchodilators

Unlike a short-acting broncodilator, you usually use a long-acting bronchodilator at regular intervals every day instead of as-needed. You will usually use it once or twice per day to stave off chronic, recurring symptoms of COPD.

Long-acting bronchodilators work around the clock to keep the muscles around your lungs relaxed. They effectively work to relieve respiratory symptoms and help many people with COPD breathe easier.

There are several types of long-acting bronchodilators, separated into two categories: those that only use a bronchodilator medication, and those that combine two bronchodilators or one bronchodilator with a corticosteroid.

Examples of long-acting bronchodilator only medications:

  • Arformoterol (Brovana)
  • Formoterol (Foradil)
  • Indacaterol (Arcapta), Salmeterol (Serevent)

Examples of combination long-acting bronchodilator medications:

  • Glycopyrrolate/Formoterol (Bevespi Aerosphere)
  • Lycophyrrolate/Indacaterol (Utibron Neohaler)
  • Tiotropium/Olodaterol (Stiolto Respimat)

Examples of combination long-acting bronchodilator and corticosteroid medications:

  • Budesonide/Formoterol (Symbicort)
  • Fluticasone/Selmeterol (Advair)
  • Fluticasone/Vilanterol (Breo Ellipta)

Antibiotics and Corticosteroids

Depending on how severe your COPD symptoms are and how often you experience exacerbations of your symptoms, your doctor might recommend antibiotics or corticosteroid medications.

COPD leaves you more vulnerable when you get sick with an infection, so your doctor might prescribe you antibiotics to prevent an exacerbation (a period of time—often days or weeks—when your symptoms flare up and worsen).

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If you get sick, your doctor might prescribe antibiotics to prevent complications, but in some cases your doctor might recommend a long-term preventative antibiotic. The antibiotic Azithromycin, while not currently officially approved for treating COPD, has been shown to reduce the number of exacerbations in patients with severe COPD symptoms.

Corticosteroids are another type of medication that can prevent COPD exacerbations and help you breathe easier. They help fight inflammation in your airways, improving lung function by reducing swelling and excess mucous production.

There are two types of steroid medications commonly used for COPD patients: oral steroids and inhaled steroids. Oral steroids (such as Prednisone) are used to improve overall general lung function, while inhaled steroids (such as Fluticasone, aka Flovent) are usually used during exacerbations, when symptoms rapidly get worse.

Stage 2 Overview

Most people first see a doctor and get diagnosed when they have reached stage 2 of COPD. This is the point at which symptoms become get too bad to be ignored and require medication to manage.

There are many treatment options available and time to make lifestyle changes that will slow your COPD from progressing. People with stage 2 COPD should focus on setting up a health diet and exercise plan that they can stick to long term.

If you have stage 2 COPD, you need to be working with a doctor to monitor your symptoms and lung function, and make sure you have the proper medication to help you deal with breathing difficulties. There's usually no need for supplemental oxygen therapy devices at this point in the disease, but it's important to have a detailed treatment plan that combines healthy habits and medication.

Stage 3: Severe COPD

At stage 3 COPD, the disease has progressed and lung function further decreased. Symptoms are usually pretty severe and require intensive treatment to manage.

You will notice your breathing difficulties become more than bothersome at stage 3, and they will likely interfere with everyday activities.

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Stage 3 COPD Symptoms

COPD symptoms at stage 3 are more serious and frequent than at the previous stages. You might also notice new symptoms you didn't have before.

Here are some of the common symptoms associated with stage 3 COPD:

  • Worsening breathlessness
  • Worsening fatigue
  • Serious breathing difficulty when you do even mild activity
  • Difficulty maintaining a healthy weight
  • Worsening fatigue
  • Headaches in the mornings
  • Feet or ankle swelling (edema)
  • Increased number of symptom exacerbations
  • FEV1 Value of 30-49% of normal

What you will likely notice most is that your symptoms are more debilitating and come more often than they did previously. As your symptoms add up you will need to pay even more attention to how your body feels and monitor your symptoms more carefully.

Treatment Options

At this stage, people with COPD require more intensive and frequent medical care. As symptoms worsen, they become more difficult to control, so it's important to work with a doctor to monitor your respiratory symptoms and lung function carefully.

You will continue to utilize many of the treatment options from stages 1 and 2, but at this point you may also benefit from supplemental oxygen treatment.

Regularly Testing Pulmonary Function

At stage 3, you will likely have to visit your doctor more often for lung function tests. This will help you monitor the severity of your disease and determine whether your treatment plan is working.

Your doctor will want to perform tests and keep close track of your symptoms. This will make sure that, if any changes are detected, you will be able to adjust your medication and treatment plan accordingly.

(Video) What Are the 4 Stages of COPD and the Symptoms of Each

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Avoiding Pollutants and Lung Irritants

Avoiding lung irritants becomes more and more important the more severe your COPD gets. Avoid areas with secondhand smoke, pollution, fragrances, and pollen.

You can check with your local weather service or go online daily to see the air quality rating for your area. On days with heavy pollution or pollen, limit your time outdoors and be prepared to manage more severe symptoms.

When you cannot avoid environments that could exacerbate your symptoms, you should take care to have the proper medications (e.g. inhalers) and equipment (e.g. dust mask or supplemental oxygen therapy) to help you manage your symptoms.

Precautions to avoid lung irritants for people with COPD:

  • Keep an N95 face mask ready when you go in public to protect you from environmental pollutants and irritants you can't avoid
  • Check the air quality in your area before you leave the house, and limit outdoor activities on days with heavy smog (
  • Check pollen advisories in your area before leaving the house if you have allergies (

Vaccinating and Avoiding Illness

Vaccinating against influenza is still important at this stage of the disease, but at stage 4 protecting yourself from illness becomes even more important. You will need to take extra precautions when going into densely populated areas, especially during cold and flu season.

To prevent illness and exacerbations, take care to practice proper hygiene. That means washing your hands often and avoiding touching your face or mouth in public.

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Wearing an N95 mask in public is another step you can take to protect yourself from airborne particles and viruses. You can also reduce your risk of disease by using disinfectant wipes to sanitize commonly touched surfaces like shopping carts and doorknobs.

Supplemental Oxygen Therapy

Some people need supplemental oxygen earlier, but most people with COPD aren't prescribed oxygen therapy for COPD until stage 3. Whether or not you need supplemental oxygen will depend on your SPO2 levels, which is a measure of the amount of oxygen in your blood.

As your lung function declines and your lungs are no longer able to supply your body with enough oxygen on their own, you will need to supplement them with oxygen from a home or portable oxygen generator or oxygen tank.

Although many people who need oxygen therapy devices first see it as a burden, you will find that it can greatly improve your symptoms and extend your lifespan. Don't see it as a hindrance or a crutch, but an opportunity that allows you to continue living an active, normal life.

Here are some of the benefits you can get by using supplemental oxygen:

  • Improved quality of life
  • Extended lifespan
  • Decreased wheezing and breathlessness
  • Increased endurance and reduced fatigue
  • Reduced morning headaches
  • Slowed cardiovascular decline
  • Reduced risk of heart failure

At stage 3, portable oxygen therapy can be used before or during physical activity, while you sleep, or, in more sever cases, all the time.

Supplemental Oxygen Options: Portable Oxygen Concentrators

Portable oxygen concentrators come in many different varieties and sit at the forefront of oxygen technology innovation. They are battery-operated, portable, and use the regular, ambient air around you to produce pure, medical-grade oxygen for you to breathe.

Using a lightweight portable oxygen concentrator doesn't only relieve breathlessness, but it can help you avoid back-pain, but there could be other reasons for back pain while breathing that you expierence.

The benefit of portable oxygen concentrators is that they don't require constant refills or replacement tanks like other supplemental oxygen products. They also come in a variety of sizes, weights, and oxygen concentrations so you can choose the one that works best for your needs.

Small portable oxygen concentrators utilize a pulsed oxygen flow, and might not meet the needs of someone who needs consistent large doses of oxygen. The larger devices, however, can provide more oxygen in a continuous flow.

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Talk to your doctor to determine how much oxygen you need and whether a pulse-flow or continuous-flow machine is better for you. What's most important is to make sure you find a device that supplies a sufficient amount of oxygen and brings you the maximum amount of comfort.

Liquid Oxygen

Liquid oxygen tanks are a popular option because they can be easily refilled from a home reservoir. They last longer than standard oxygen tanks, and don't have to be replaced as frequently.

Unlike portable oxygen concentrators, liquid tanks carry the same risks as standard oxygen tanks. They must be handled with care to avoid damage (and possible explosion) and are banned from airplanes.

However, the benefit is that it can provide a larger volume of oxygen than a portable concentrator, and it's a better option for those with severely decreased lung function.

Standard Oxygen Tanks

The standard supplemental oxygen tank is the most commonly used oxygen supply for people with COPD. They are the traditional option and tend to be lower cost, but they have the downside of being less convenient.

Standard oxygen tanks don't hold as much oxygen as a liquid oxygen tank, and they cannot be refilled from a home reservoir. Instead, standard tanks must be picked up by an oxygen supplier and regularly replaced with a fresh tank.

Standard oxygen tanks come in a wide variety of sizes, ranging from very large tanks to keep in your home, medium tanks that can be rolled on carts, and small tanks that you can carry by hand. You will want to choose an option that best fits your individual lifestyle and allows to continue living a rich, active life.

Overview of Stage 3 COPD

By the time you have stage 3 COPD, your lung function has declined to the point that supplemental oxygen and more intensive medication is usually necessary. Unlike the previous stages, stage 3 symptoms are very severe and take intensive treatment to manage.

At this point, you will likely be meeting with your doctor for more frequent lung function tests to see what medications are working and adjust your treatment plan as your symptoms change. You might have to use supplemental oxygen to get through physical activity or to keep your oxygen levels stable at night.

Overall, you will be following a more intense and strict treatment plan that includes healthy lifestyle choices, medication, and oxygen therapy. With a good doctor and proper vigilance, you should still be able to manage your symptoms and slow your disease progression with these steps.

Stage 4: Very Severe COPD

Getting a stage 4 COPD diagnosis can be terrifying, to say the least. But even though it's sometimes referred to as “end stage” COPD, it isnotthe end of your life and it isnota death sentence.

At this stage, lung function has declined to about 30% or less of normal (as determined by FEV1 tests). However, the severity of symptoms and how much they interfere with daily activities can vary greatly from person to person.

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Your quality of life at stage 4 depends largely on healthy lifestyle choices and having an effective, tailored treatment plan that includes medication and supplemental oxygen. Far from defeated by their disease, many people with stage 4 COPD live happy, active lives for many years.

As your symptoms worsen and become more difficult to manage at this stage of the disease, you will need to be more vigilant than ever at adhering to your treatment plan and adjusting it when symptoms change or worsen. That means carefully tracking symptoms with your doctor, taking medication on time, and sticking with your healthy diet and regular exercise routine.


At stage 4, breathing is often very difficult without supplemental oxygen and other symptoms like headaches and edema become more persistent. Additionally, the lack of oxygen in your blood begins to wear on your cardiovascular system, leading to heart and circulatory problems.

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You will probably find that you are more prone to getting sick, your symptoms are even more persistent, and you need more frequent medical interventions or hospitalizations. Breathing difficulties can be life threatening at this point, and it's essential to prevent exacerbations or detect and treat them very early.

(Video) 4 Stages of COPD Explained: Stage 4 - Severe COPD (Living Healthy with COPD)

Here are some of the common symptoms associated with stage 4 COPD:

    • Significant difficulty breathing, airflow obstruction
    • Tightness in your chest
    • Chest and abdominal pain
    • Difficulty maintaining a healthy weight
    • Cardiovascular problems
    • Depression
    • Drowsiness and fatigue
    • Confusion and disorientation
    • FEV1 below 30% of normal

Symptoms can vary greatly from person to person, and maintaining a positive, can-do attitude is key. As long as you can keep yourself motivated to stay active, comply with treatment, and focus on what you enjoy, you can truly make the best of your situation.

Just like the COPD athlete says, “Managing your condition can be difficult, but it can be done.”

Stage 4 COPD Treatment Options

Treating stage 4 COPD takes more care and vigilance than ever before. Working with your doctor on a regular basis is essential in order to tailor your medication and other treatments to your changing needs.

Typical treatment for Stage 4 COPD generally includes:

  • Strict diet (nutritious, whole foods, no processed foods, etc.)
  • Regular activity and a tailored exercise plan
  • A regular medication schedule
  • Pulmonary rehabilitation
  • A COPD action plan

You will probably find yourself spending even more time with your doctor than before. Your doctor will need to take more frequent lung function tests and evaluate your symptoms more frequently in order to quickly detect and treat any declines.

You will continue to use supplemental oxygen and many of the treatment methods used for previous stages of COPD, but at stage 4 you might have the option of considering some more drastic operations like lung surgery.

Lung Surgery

Lung surgery is a very invasive and serious procedure that is usually reserved as a last resort for people who cannot manage their COPD in any other way.

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Whether or not you are eligible for lung surgery depends greatly on the severity of your symptoms, how difficult they are to manage, and your likelihood of recovering well from the procedure.

If conventional treatments and oxygen therapy are no longer effectively keeping your symptoms at a manageable level, your doctor might recommend some form of lung surgery.

Lung Volume Reduction Surgery

It might sound counter-productive toreducelung volume to treat COPD, but doing so can actually make it easier to breathe. In lung volume reduction surgery, a surgeon will remove some of the diseased tissue in the lungs which gives the healthier tissue more room to breathe and expand.

This kind of surgery can have many benefits, including less frequent exacerbations and an overall reduction in COPD symptoms. It can make it easier to breathe so you can stay active and exercise without your debilitating symptoms holding you back.

However, only some people are eligible, and it will be up to your doctor to determine whether you would benefit from lung reduction surgery. It depends on the severity of your symptoms, your individual disease history, your current health, and your personal risk of infection or other complications.

Good candidates for lung volume reduction surgery usually meet these criteria:

  • Severe emphysema that doesn't respond to conventional medicines and therapies
  • Non-smokers who have quit for at least 4 months
  • Disease allows certain parts of the lungs to be effectively targeted
  • Under the age of 75

Lung reduction surgery isn't a cure for COPD, but it can greatly reduce your symptoms and improve your ability to enjoy life. The extra hope, energy, and breathing ability it gives you can help you stay active and continue treatment that could slow the disease from progressing further.

There's much more to lung surgery that what we can cover here. If you are ever eligible for lung surgery, your doctor can help you better understand the procedure and its risks and benefits for you.

Lung Transplant Surgery

Another surgical option available to some stage 4 COPD patients is a complete lung transplant surgery. This is an extremely serious and risky procedure reserved as a very last resort for people with the most severe and unmanageable symptoms.

Your doctor will not likely recommend a lung transplant unless you are unable to survive without it, or your symptoms are so severe that you cannot live a decent quality of life.

Lung transplant surgery is expensive, dangerous, and requires a lengthy recovery. Even after a successful transplant, you would need to take immunosuppressants for the rest of your life to prevent complications.

Good candidates for lung transplant surgery usually meet these criteria:

  • Severe, late-stage COPD
  • Non-smoker or drug user
  • Under 65 years old
  • In good enough health to tolerate and recover from surgery
  • High chance of complying with post-op treatment and therapy

There are other strict criteria, as well, since it is such a traumatic surgery and since organ transplants are in such high demand. It's not suitable for everyone with stage 4 COPD.

Risks associated with lung transplant surgery:

  • Rejection of the new organ by your immune system
  • Increased risk of cancer and illness from immunosuppressant medications
  • Blood loss and blood clots
  • Increased risk of diabetes
  • Kidney damage and stomach problems
  • Acceleration of osteoporosis

Even if you are approved for a lung transplant, there are often long waiting lists for organs and finding a match is no guarantee. However, successful surgery can greatly reduce your symptoms and even extend your life.

Stage 4 COPD Overview

Your symptoms at stage 4 COPD may be severe and difficult to manage, but it does not mean it's the end. There is no ticking timer or firm life expectancy at stage 4, and you can still live comfortably for many years.

The stigma and fear associated with this stage of the disease can be the most difficult thing to deal with, but it's important to remember that every person and patient is different. Your quality of life depends greatly on having a healthy lifestyle, working with a good doctor, and keeping your spirit and optimism up.

COPD doesn't have to define your life. If you keep hope, make healthy choices, and focus on your passions, then you are already winning the battle with your disease.


The earlier you catch COPD, the better your chances to slow the disease's progression and maintain a high quality of life. Unfortunately, many people aren't diagnosed until stage 2 or later, at which point symptoms are more difficult to manage.

But no matter how far your disease has progressed, there are many different treatment options and many ways to improve your symptoms and quality of life. With a little luck and motivation, you might find yourself even healthier and happier after treatment than before you were diagnosed.

Learning everything you can about COPD and its different stages can empower you to take action and help reduce any fear and uncertainty you have about the future. Understanding your particular stage of COPD will also help you understand what kinds of changes to expect and what kind of treatment options there are to manage your symptoms and keep them from getting worse.

When you're diagnosed with COPD, the best thing you can do is keep a positive attitude and be proactive in building a healthier lifestyle for yourself. Maintaining a healthy diet, a regular exercise routine, and a supportive system of friends and doctors will make all the difference in helping you live a full and comfortable life.

Living with COPD is not easy, but the effort of making and sticking to a good exercise, diet, and medication plan is certainly worth the struggle.

As the COPD athlete says, “Set yourself a goal to help keep you on track and always remember no matter how tough it gets there's always someone doing it tougher than you. Put simply, the body will do what the mind tells it to!”

Topics: COPD, Medication and Treatment, Respiratory Resource Center, portable oxygen concentrator, oxygen therapy

The 4 Stages of COPD: What You Need to Know (19)

(Video) What to Know About the Four Stages of COPD: Stage 1 - mild COPD (Living Healthy with COPD)

Written by Duke Reeves


What are the 4 stages of COPD? ›

There are four distinct stages of COPD: mild, moderate, severe, and very severe. Your physician will determine your stage based on results from a breathing test called a spirometry, which assesses lung function by measuring how much air you can breathe in and out and how quickly and easily you can exhale.

What does it mean to have Stage 4 COPD? ›

End-stage, or stage 4, COPD is the final stage of chronic obstructive pulmonary disease. Most people reach it after years of living with the disease and the lung damage it causes. As a result, your quality of life is low. You'll have frequent exacerbations, or flares -- one of which could be fatal.

At what stage of COPD do you need oxygen? ›

Once a patient's COPD has progressed to the point that they begin to show continued shortness of breath even with other regular therapies, pulmonologists are likely to prescribe oxygen therapy to COPD patients who: Have oxygen saturation of 92% or below while breathing air. Experience severe airflow obstruction.

What are the 4 main symptoms of COPD? ›

Symptoms of COPD include:
  • Frequent coughing or wheezing.
  • Excess phlegm or sputum.
  • Shortness of breath.
  • Trouble taking a deep breath.

How long can you live with stage 4 COPD? ›

Stage 1: 0.3 years. Stage 2: 2.2 years. Stage 3: 5.8 years. Stage 4: 5.8 years.

Is Stage 4 COPD treatable? ›

Although there is no cure for emphysema, treatments are available to help manage the symptoms and slow the progression of the disease. By the time a person reaches stage 4 emphysema, treatment focuses on easing symptoms and boosting blood oxygen levels to prevent further complications.

Why do you not give oxygen to COPD patients? ›

Too much oxygen can be dangerous for patients with chronic obstructive pulmonary disease (COPD) with (or at risk of) hypercapnia (partial pressure of carbon dioxide in arterial blood greater than 45 mm Hg). Despite existing guidelines and known risk, patients with hypercapnia are often overoxygenated.

What is stage 4 COPD oxygen level? ›

Stage 4: Very severe

Stage 4 is considered very severe. Your forced expiratory volume is less than 30 percent of your normal value, and your blood oxygen levels will be low. You're at risk of developing heart or lung failure.

What is too much oxygen for COPD? ›

Oxygen tensions above about 50 mm Hg (saturation above about 85%) will protect patients from hypoxic injury during exacerbations of COPD. Oxygen tensions above about 75 mm Hg (saturation above about 95%) are associated with increased risk of hypercapnia and acidosis in exacerbated COPD.

What are the signs that COPD is progressing? ›

COPD progression and stages
  • a persistent cough.
  • coughing that produces excess mucus.
  • shortness of breath.
  • difficulty performing physical activity.
  • wheezing or whistling while breathing.
  • chest tightness.
Oct 13, 2021

How long is life expectancy with severe COPD? ›

People with severe stage COPD, lose about eight to nine years of life expectancy on average .

How long can someone live with mild COPD? ›

According to a 2020 study, there was no difference in life expectancy for people with mild COPD compared with those who didn't have COPD. But the same study suggests that people with moderate COPD may expect to reduce their life expectancy by 6.2 years.


1. How am I going to die
2. What to Know About the Four Stages of COPD: Stage 2 - Moderate COPD (Living Healthy with COPD)
(Living Healthy with COPD)
3. Diagnosis and Evaluation of COPD
(Animated COPD Patient)
4. CDC: Tips From Former Smokers - Geri M.: Living with Stage 4 COPD
(Centers for Disease Control and Prevention (CDC))
5. Mayo Clinic Minute: What you need to know about COPD
(Mayo Clinic)
6. COPD Life Expectancy
(COPD My Journey)


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