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The Four Stages of COPD: What You Need To Know

November 16, 2021

For most of us, a brisk walk around the block or climb up a flight of stairs is an easy activity that keeps our heart and lungs healthy. But for many, these seemingly simple movements can prove challenging because of progressive inflammatory lung conditions called chronic obstructive pulmonary disease (COPD). 

COPD causes your airways to narrow, making breathing more difficult. Primarily striking smokers over the age of 40, COPD is the third most-common cause of mortality and affects over 300 million people worldwide. Common symptoms of COPD include shortness of breath, chronic cough, frequent respiratory infections, excessive mucus production and fatigue. 

Stages of COPD 

COPD is an umbrella term that covers several different lung conditions. The two primary COPD diseases are: 

  • Chronic bronchitis — when the lung’s bronchial tubes become inflamed, causing coughing and an increased buildup of mucus

  • Emphysema — when the lung’s air sacs are damaged, reducing their elasticity, causing shortness of breath and reduced oxygen to your blood 

To determine your specific condition, your doctor will begin with a simple pulmonary evaluation called a spirometry test. For this, you’ll be asked to inhale deeply, hold your breath, and then quickly and forcefully exhale into a large tube connected to a spirometry machine. 

This measures both the velocity and the volume of your breathing capacity. Additional information or tests your doctor might need include an extended family health history, chest X-rays and an arterial blood gas test to determine your blood oxygen count.

Based on your spirometry results, the severity of your symptoms and other health problems you may have, your doctor will determine which stage of COPD you are in,  along with treatment options and life expectancy concerns. Although individuals will vary, COPD stages broadly progress as follows: 

  • Stage 1 (mild): Often little to no outward symptoms unless exerting yourself or as you age into your 50s. Symptoms may include minor shortness of breath and a nagging dry cough.

  • Stage 2 (moderate): At this stage, shortness of breath increases, along with a persistent cough and phlegm production, sleep issues and wheezing. Flare-ups may worsen symptoms and cause changes in phlegm color. Rising frustration, confusion and exhaustion begins to impact mental health.

  • Stage 3 (severe): Symptoms increase further (especially in mornings) and flare-ups are more frequent. You can feel chest tightness or wheezing with everyday tasks. Some notice swelling in their ankles, feet and legs.

  • Stage 4 (very severe or end-stage): Breathing has now become an effort with exacerbations more severe and frequent. Heartbeat can become fast or irregular. A crackling sound in the chest when breathing. Delirium, weight loss or pulmonary hypertension is possible. 

COPD Progression Can Be Slowed with Treatment 

While COPD is not reversible, its progression can be slowed and discomfort reduced with prescribed medication and lifestyle changes. Your doctor will work with you to create a pulmonary rehabilitation plan that helps you manage your COPD and treat the symptoms. Some of these steps include: 

  • Stop smoking. While there are exceptions, 85 percent to 90 percent of all COPD cases trace back to smoking. To prevent or minimize your risk, stop smoking immediately.

  • Diet changes. COPD can affect how your body metabolizes food. A diet low in carbohydrates and higher in fat can help you breathe easier.

  • Stay active. Work with your doctor to determine a safe and effective exercise plan.

  • Inhaled or oral corticosteroids. These can be effective for helping reduce airway inflammation and provide relief — or even prevent — flare-ups.

  • Quick-acting bronchodilators. These inhalers relax muscles around the airway, providing immediate relief.

  • Medication. Nebulizers deliver medication as an inhaled mist. Antibiotics can lessen infections that worsen symptoms. PDE-4 inhibitors relax airways and decrease inflammation.

  • Increased oxygen intake. There are devices available, including portable units, that deliver additional oxygen to improve breathing.

  • Surgery. In a few select conditions, there are surgical options available to reduce lung size or possibly replace your damaged lung with a donor lung. 

COPD is a painful, yet preventable, condition that lowers your life expectancy by up to ten years if not properly addressed and managed. Be sure you have an annual physical to stay ahead of any COPD flags as well other health issues that might further compound the problem.

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