What Are The 4 Stages of COPD – Plus How To Manage Them

Written by Ally Streelman

NowRx Pharmacy

What are the Stages of COPD? - NowRx

In general, there are 4 stages of COPD that are mainly diagnosed based on how well you are able to breathe. And while there is no cure for COPD, there are ways to manage your condition regardless of which stage you find yourself in.

Here we will explore each of the 4 stages of COPD in addition to providing several tips for how to manage your condition. As a result, we hope this can help you improve your overall quality of life while slowing the progression of the disease.

Let’s get started!

What is COPD?

Simply put, COPD (chronic obstructive pulmonary disease) is a progressive lung disease that is characterized by persistent respiratory symptoms and airflow limitation. It affects more than 15 million adults in the United States with common symptoms that include coughing, difficulty breathing, and sputum.

For most people, COPD is accompanied by a range of chronic conditions which increase the mortality risk of the disease. In addition, it is a progressive disease which means it gets worse over time. That can lead to a number of additional health complications like susceptibility to infection, heart problems, and more. As a result, COPD is one of the leading causes of death in the United States.

In general, the main risk factor for COPD is tobacco smoke, although genetics may also play a role. In other words, one of the best ways to prevent COPD is to avoid or quit smoking. If you are trying to quit, talk to a qualified healthcare professional, and be sure to check out these simple tips to help you stop smoking!

What is COPD exacerbation?

A COPD exacerbation, also known as a flare-up, is when respiratory symptoms worsen suddenly and acutely resulting in additional therapy. This is usually associated with increased airway inflammation and mucus production as well as gas trapping or an inability to fully exhale.

While there are many causes of COPD exacerbation, the most common are respiratory tract infections. The more severe your COPD is the more often you’re likely to experience COPD exacerbations.

If you believe you or a loved one is having a COPD exacerbation you should seek medical attention immediately.

How is COPD diagnosed? 

COPD is diagnosed using a test called spirometry. Simply put, this test measures lung function by having individuals breathe in and out as forcefully as possible.

The spirometer records the amount as well as the rate of inhalation and exhalation over a set period of time. Then the results are compared to normal values for somebody similar in age, height, and sex to determine if your lungs are working properly.

In addition, your doctor may also order imaging, lab work, or a number of other tests as part of the diagnosis and assessment. For example, although an X-ray will not diagnose COPD, it is useful in ruling out alternative diseases while providing a more well-rounded picture of the patient’s condition.

If you are experiencing symptoms of COPD such as chronic cough or trouble breathing, don’t wait. Visit your doctor and tell them about your symptoms so they can order the appropriate testing as soon as possible. Early detection is critical in managing the condition and preventing the progression of the disease moving forward.

COPD Risk Factors 

Smoking is the most significant risk factor for COPD. In fact, an estimated 85-90% of all COPD cases are caused by cigarette smoking. However, there are other risk factors that can influence the development of the disease including:

  • Exposure to air pollution
  • Working with chemicals, dust and fumes
  • Genetics (Alpha-1 deficiency)
  • History of childhood respiratory infection

 Talk to your doctor if you are experiencing symptoms and think you may be at risk for COPD.

What Are The Stages of COPD?

The 4 stages of COPD are mild, moderate, severe, and very severe. These stages group patients based on their FEV-1 and allow doctors to better understand the severity of COPD as well as help determine an appropriate treatment plan. Simply put, FEV-1 is the maximum amount of air that a patient can forcibly exhale during the first second following maximum inhalation.

Let’s take a look at each of the 4 stages of COPD, how they are different, and what the treatment plan might look like for each.

4 Stages of COPD

The 4 stages of COPD are based on a patient’s FEV-1 results and help doctors to better understand the severity of a patient’s COPD so they can prescribe an appropriate treatment plan.

Let’s take a look at what each stage means and how that impacts the likely treatment plan.

Stage 1 – Mild

Patients in COPD stage 1 are characterized by an FEV-1 >80%. Patients in this stage may have minimal or no symptoms, however, there is still damage to the lungs. You may be short of breath when walking fast or at a slight incline. Many people do not seek a diagnosis at this point which can cause the disease to progress.

Treatment: The best treatment for stage 1 COPD depends on the amount and severity of symptoms the patient is experiencing. Treatment at this stage may consist of medication and pulmonary rehabilitation and you will almost certainly need to make lifestyle changes to prevent disease progression. This includes quitting smoking and avoiding secondhand smoke. Getting flu and pneumonia vaccinations are incredibly important as these can be especially dangerous to patients with COPD.

Stage 2 – Moderate

Patients in COPD stage 2 are characterized by an FEV-1 between 50-59%. You may need to stop every few minutes while walking to catch your breath. Symptoms at this stage can include persistent cough, shortness of breath, and fatigue. Damage to the lungs at this stage is typically when people seek a diagnosis.

Treatment: The goal of treatment in stage 2 COPD is to relieve symptoms and keep the lungs working as much as possible. Pulmonary rehabilitation and medication such as bronchodilators are the main treatment options at this point. Depending on exacerbations or frequency of flare-ups, your doctor may prescribe additional treatment or higher doses of your regular medication.

Stage 3 – Severe

Patients in COPD stage 3 are characterized by an FEV-1 between 30-49%. Any physical activity may leave you short of breath including moving around the house. At this stage, symptoms are likely frequent and there is extensive damage to the lungs. There is likely a significant reduction in quality of life.

Treatment: At stage 3 COPD you will have much of the same treatment and goals as stage 2. In addition, oxygen therapy may be required although the frequency will depend on the progression of the disease. You may also need steroids or antibiotics more often to manage exacerbations.

Stage 4 – Very Severe

Patients in COPD stage 4 are characterized by an FEV-1 ≤30%. Sometimes called end-stage COPD, you find it hard to catch your breath even when resting. Likely comorbidities may include lung or heart failure. You may require assistance to breathe due to extensive damage to the lungs. Symptoms will be the same as stage 3 but more frequent.

Treatment: Like earlier stages, stage 4 COPD will use some combination of medication, pulmonary rehab, and oxygen therapy for treatment. In addition, surgery may be necessary for extreme cases. Your doctor may suggest focusing on the quality of life and easing symptoms/pain during end-stage COPD.

Gold Stages COPD

Gold stages created by the Global Initiative for Chronic Obstructive Lung Disease have improved in recent years to account for symptoms and exacerbations in an effort to improve treatment recommendations. For example, historically specific spirometer cutoff points were used for simplicity.

However, there is a weak correlation between FEV-1, symptoms, and impairment of health. As a result, the most recent recommendations take into account patient symptoms and exacerbations to provide greater context for each stage.

The following grades are provided in addition to each stage and can help guide recommended treatment plans:

  • Grade A – 0 to 1 exacerbations not leading to hospitalization with low reported symptoms.
  • Grade B – 0 to 1 exacerbations not leading to hospitalization with high reported symptoms.
  • Grade C – 2 or more exacerbations or 1 that required hospitalization with low symptoms.
  • Grade D – 2 or more exacerbations or 1 that required hospitalization with high symptoms.

While stages can indicate the extent of airway blockage, each grade can provide context that can be extremely valuable in guiding treatment options. Always consult your doctor if you have any questions regarding your symptoms or treatment plan.

Treating COPD

While each treatment plan will depend on the individual and their specific circumstance, common treatments for COPD will likely include medication and pulmonary rehabilitation.

Medications, such as bronchodilator medication, which often comes in COPD inhalers or nebulizers, can help you breathe easier and reduce COPD exacerbations. Pulmonary rehabilitation programs help rebuild strength and prevent progression through exercise and nutrition education and counseling. 

These methods are typically most effective in patients with mild to moderate COPD. As COPD worsens, it’s more likely that a patient will need oxygen support, steroids, and even surgery. This is why early detection is key to helping slow the disease’s progression and maintaining a good quality of life.

If you have COPD, talk to your doctor about the available treatment options and which ones can best reduce your symptoms and enhance your quality of life.  

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Global Initiative for Chronic Obstructive Lung Disease

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