COPD Stages

What are the COPD stages?

COPD, or chronic obstructive pulmonary disease, is a long-term disease that affects the lung’s ability to transfer oxygen to the bloodstream and makes it difficult for people to breathe. The stages of COPD show how the disease can worsen over time. Each stage is treated slightly differently, and understanding this can help people know how to best manage their condition to slow down its progression.

 

The diagnosis of COPD is confirmed with a spirometry test, which measures lung function. The test is done using a spirometer, a device that a patient breathes into. A spirometer measures the amount of air a person inhales, exhales, and the amount of time it takes for them to exhale completely after a deep breath.

Doctors may also administer medications, like puffers, during the test to see if they improve lung function. Naturally, this test requires a lot of deep breathing and can be exhausting for people with COPD.

What is FEV1?

The lungs are stretchy and have elastic recoil. They should be able to take in and push out air quickly. However, COPD damages this elasticity and causes people to need more time to fully empty their lungs.

 

Spirometry measures FEV1, which stands for Forced Expiratory Volume in one second—or how much air a person can exhale, or push out, in one second.

In each case, the FEV1 percentage represents how much air the lungs can handle. The lower the FEV1 percentage, the more damaged the lungs are and the more severe the COPD is. Roughly speaking,

• If your FEV1 is 50%, your lungs can handle about half of what they should.
• If your FEV1 is 25%, your lungs can handle about one-quarter of what they should.

The 4 stages of COPD

COPD is divided into four stages: mild, moderate, severe, and very severe. These stages are based on a person’s severity of symptoms, their lung function measured with spirometry, and the number of exacerbations (or flare-ups) they experience each year. Keep in mind that everyone is different and may not fit perfectly into one group. Here is everything people need to know about these four stages:

Stage 1: Mild COPD

People with stage 1 COPD have an FEV1 of 80% or higher.

 

The symptoms

At this stage, people have no or very mild symptoms:

• A mucus-producing cough
• Shortness of breath with strenuous physical activity
• A feeling of tightness in the chest
• A whistling sound, also known as wheezing, when breathing

 

People with stage 1 COPD often experience shortness of breath during certain physical activities, such as walking on an incline or moving quickly across level ground. They may view this shortness of breath as merely a sign of getting older when really, it’s an important indicator of lung disease.

 

The prognosis
People with stage 1 COPD generally have no more than one COPD exacerbation per year and do not need to be hospitalized for it. Over time, their symptoms may include a chronic cough and frequent respiratory infections.
Most of the time, a person’s condition will worsen slowly, and symptoms gradually become more severe.

 

The treatment plan
The most important thing people with stage 1 COPD can do is learn about the disease and how their actions can slow it down. This includes:

• Quitting smoking
• Avoiding lung irritants like cigarette smoke, air pollution, and chemicals
• Exercising regularly to improve heart and lung function
• Eating well
• Getting routine immunizations (e.g., pneumonia and flu)
• Developing an ongoing treatment plan with a health care professional
• Short-acting bronchodilator inhalers (a.k.a. reliever puffers or SABAs)

Stage 2: Moderate COPD

People with stage 2 COPD have an FEV1 between 50% and 79%.

 

The symptoms

At this stage, symptoms are more noticeable and new symptoms may appear, such as:

• Cough, breathlessness, and sputum (mucus or phlegm) on most days
• Chest tightness
• Wheezing
• Frequently needing to stop and catch one’s breath

 

The prognosis
With stage 2 COPD, exacerbations still don’t happen often—usually only once a year—and don’t require a hospital stay. The progression is different for everyone—one person may quickly go from moderate to very severe within a few years, while others will have a decade or more before their health gets much worse.

 

The treatment plan
People with stage 2 COPD can slow the disease progress with:

• Quitting smoking
• Avoiding lung irritants like cigarette smoke, air pollution, and chemicals
• Exercising regularly to improve heart and lung function
• Eating well
• Getting routine immunizations (e.g., pneumonia and flu)
• Following an ongoing treatment plan with a health care professional
• Short-acting bronchodilator inhalers (a.k.a. reliever puffers or SABAs)
• Long-acting bronchodilator inhalers (a.k.a. LABAs or LAMAs)
• Pulmonary rehabilitation

Stage 3: Severe COPD

People with stage 3 COPD have an FEV1 between 30% and 49%.

 

The symptoms

By stage 3 COPD, lung function is more limited and symptoms include:

• Cough, breathlessness, and sputum (mucus or phlegm) on most days
• Chest tightness
• Wheezing
• Frequently needing to stop and catch one’s breath

PLUS, people with stage 3 COPD generally have more than one exacerbation per year and may need a hospital stay.

 

The prognosis
At this stage, people are often very tired and find it hard to exercise. Acute flare-ups, or exacerbations, are more common and may be more severe. The overall quality of life can decline but people can still slow down the disease by getting proper treatment.

 

The treatment plan
People with stage 3 COPD can slow the disease progress with:

• Quitting smoking
• Avoiding lung irritants like cigarette smoke, air pollution, and chemicals
• Exercising, if possible, to improve heart and lung function
• Eating enough calories or consulting a dietitian
• Getting routine immunizations (e.g., pneumonia and flu)
• Following an ongoing treatment plan with a health care professional
• Short-acting bronchodilator inhalers (a.k.a. reliever puffers or SABAs)
• Long-acting bronchodilator inhalers (a.k.a. LABAs or LAMAs)
• Pulmonary rehabilitation
• Oral medications (e.g., corticosteroids and antibiotics)
• Humidified high flow therapy (like myAIRVO™)
• Oxygen therapy

 

One of the most important ways to slow the disease is managing COPD exacerbations. Each exacerbation affects lung function and ability to breathe, and can even push a person into the next stage of COPD. To avoid this, it’s important for people to seek treatment as quickly as possible when they experience an exacerbation. Treatment may include humidified high flow, oxygen, steroids, and antibiotics.

Stage 4: Very severe COPD

People with stage 4 COPD have an FEV1 of less than 30%.

 

The symptoms

At this stage, ongoing shortness of breath significantly affects quality of life. People are almost constantly out of breath, making everyday activities, such as dressing and eating, a challenge.
During some episodes, shortness of breath can even become life-threatening. People may also notice:

• Weight loss
• Irregular heartbeat
• Confusion

 

The prognosis
Most people reach this stage after years of living with the disease. At stage 4, people will have frequent exacerbations (more than two per year) that usually require longer hospital stays.

 

The treatment plan
Stage 4 COPD is also known as end-stage COPD. This means that the lung function has almost completely deteriorated. There are still, however, treatment options at this stage:

• Quitting smoking
• Avoiding lung irritants like cigarette smoke, air pollution, and chemicals
• Exercising, if possible, to improve heart and lung function
• Eating enough calories or consulting a dietitian
• Getting routine immunizations (e.g., pneumonia and flu)
• Developing an ongoing treatment plan with a health care professional
• Short-acting bronchodilator inhalers (a.k.a. reliever puffers or SABAs)
• Long-acting bronchodilator inhalers (a.k.a. LABAs or LAMAs)
• Pulmonary rehabilitation
• Oral therapies (e.g., corticosteroids and antibiotics)
• Humidified high flow
• Oxygen therapy
• Noninvasive ventilation / BiPAP (breathing machines)
• Lung surgery or transplant
• Mental health care
• Spiritual care
• Palliative care

 

People with end-stage COPD may benefit from consulting a palliative care specialist. These providers specialize in providing care that brings comfort to patients and their loved ones and improves quality of living. You do not need to be close to death to ask for palliative care, and in some cases, palliative care can actually extend a person’s life expectancy. Palliative care can also be done at the same time as a person’s regular treatments.

 

For people with end-stage COPD, there are palliative care medications to help lower the work of breathing, slow mucus production, and relieve the anxiety that comes with being short of breath. Palliative care, also known as comfort care, looks different for every person and is focused on bringing them the maximum amount of comfort and support.

 

People with COPD at any stage should also discuss their wishes for personal care with their family or close friends, a process known as advanced care planning. Plans and wishes for a person’s care (also known as advanced care directives) can be put into writing before a major illness event (like hospitalization) so that if a person is ever unable to speak for themselves, their wishes for treatment will be known.

Want to know more?

Learn how a COPD action plan can help you manage the disease here.